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Legg-Calve-Perthes Disease

(LCPD; Osteonecrosis of the Hip; Avascular Necrosis; Ischemic Necrosis; Coxa Plana; Osteochondritis)

Definition

Legg-Calve-Perthes disease (LCPD) is a rare hip disease. It affects children 2-12 years old. LCPD is a disorder of the top of the leg bone. The disorder interrupts blood flow to the hip. The loss of flow impairs bone growth and causes deformity. Over time, the bone breaks and reforms causing the child to limp. LCPD most often occurs in just one hip, with only about 10% of cases involving both sides.
Hip Joint
hip socket
Damage and repairs to the femoral head causes a limp.
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Causes

The cause of LCPD is unknown. Infection, trauma, and inflammatory processes are possible causes.

Risk Factors

Factors that may increase your child’s chance of developing LCPD include:
  • Small or short for age
  • Delayed bone age
  • Athletic, active child
  • Race: Asian, White, Eskimo
  • Secondhand smoke exposure
  • Sex: Male
  • Age: 4-8 years
  • Blood clotting abnormalities

Symptoms

The primary symptom of LCPD is a limp when walking. This can occur in children 2-12 years old. It peaks in children 4-8 years old. Other symptoms may include:
  • Hip pain
  • Groin, thigh, or knee pain
  • Reduced range of motion in the hip
  • Shortening of the leg, or legs that are not the same length
  • Muscle weakness in the upper thigh

Diagnosis

Your doctor will ask about your child’s symptoms and medical history. A physical exam will be done. During the exam, your child’s hip will be examined to see how far it can move. The doctor may refer your child to a specialist. An orthopedist focuses on bones and joints.
Images may need to be taken of your child's bones. This can be done with:

Treatment

Talk with your doctor about the best plan for you. Options include the following:

Physical Therapy

If your child’s symptoms are mild, your doctor may prescribe physical therapy. A therapist will work with your child to maintain range of motion. You may be taught certain exercises to do with your child at home.

Medical Treatment

Medical treatment is used to prevent further injury to the hip. It may include using crutches , traction, a brace, or cast.
Medical treatment is used to prevent further injury to the hip. It may include using crutches , traction, a brace, or cast.

Surgery

In some cases, your child may need surgery. Bone removal may be done to reposition or reshape the hip bone.

Prevention

There are no known ways to prevent this rare disease.

RESOURCES

American Academy of Family Physicians http://familydoctor.org

National Osteonecrosis Foundation http://www.nonf.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Adkins S, Figler R. Hip pain in athletes. Am Fam Physician. 2000 Apr 1;61(7):2109-2118. Available at: http://www.aafp.org/afp/20000401/2109.html . Accessed May 7, 2013.

Kleigman, Behrman, Jenson, Stanton, Eds. Nelson Textbook of Pediatrics .18th Edition. Saunders Elsevier, Philadelphia PA, 2007.

Legg-Perthes disease. National Osteonecrosis Foundation website. Available at: http://www.nonf.org/perthesbrochure/perthes-brochure.htm . Accessed May 7, 2013.

Leet AI, Skaggs DL. Evaluation of the acutely limping child. Am Fam Physician. 2000 Feb 15;61(4):1011-1018. Available at: http://www.aafp.org/afp/2000/0215/p1011.html . Accessed May 7, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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