Information From Your Health Care Provider

LEGG-CALVÉ-PERTHES DISEASE

(Slipped Femoral Epiphysis; Coxa Plana)

Basic information

description

Legg-Calvé Perthes disease is a hip disorder of childhood. It involves gradual weakening of the head of the thigh bone where it meets the pelvis. It can involve either leg at the hip joint. It affects children ages 2 to 12 years (most often 4 to 10) of both sexes, but it is more common in boys (80% of the patients).

FREQUENT SIGNS & SYMPTOMS

Pain and stiffness in the hip and thigh. Sometimes both sides are involved.
Pain in the leg and often in the knee, even though the disorder is in the hip.
Limping or other problems with walking.
Symptoms usually begin slowly over time.

causes

The bone becomes weak due to lack of a blood supply to the top of the bone. The weak bone is not able to handle weight. Why this occurs is unknown. It may involve growth hormones in the body or blood clotting problems. Injury is usually not a factor.

risk increases with

Boys more than girls. Ages 4 to 10.
Whites, Eskimos, and Asians are more at risk.
Possible risks: children who had low birth weight (less than 5 1/2 pounds) and are small for their age and very active; and secondhand smoke exposure.

PREVENTIVE MEASURES

No specific preventive measures.

expected outcomes

Often curable in 2 to 3 years with early treatment. The blood supply to the bone becomes normal, and new bone cells start growing to replace the old bone.

possible complications

May cause permanent hip problem.
Osteoarthritis may develop later in life.

diagnosis & treatment

general measures

Your child's health care provider will do a physical exam and ask questions about the symptoms. Medical tests usually include x-rays or other tests to determine how far the problem has progressed.
Treatment depends on several factors: age and health of the child, extent of the disorder, child's tolerance for treatment procedures, and your preferences.
Treatment may not be recommended for some patients with the disorder. These children will be watched to see if any problems develop. This can include children younger than 6 with no hip motion problems. Older children are usually treated.
Treatment options are aimed at maintaining the range of motion and keeping the hip bone in the hip socket (called containment). Options include rest, limiting activities, drugs for inflammation, a cast, brace, physical therapy, traction, use of crutches (or wheelchair), or surgery.
Use heat to relieve pain. Warm compresses, heating pads, or other methods are effective.
Surgery to reinforce the bone's attachment to the joint and prevent further problems may be needed.
Traction therapy (involves equipment that places a steady pull on the leg) may be prescribed.

medications

For minor discomfort, use nonprescription drugs, such as acetaminophen or ibuprofen. Don't give aspirin to children.

activity

A limited amount of bedrest may be prescribed. Certain activities may be limited, such as running. An activity such as swimming may be recommended.
A child can and should attend school.
A physical therapist can teach the child some simple exercises to do to maintain hip movement.
Young children often have difficulty accepting the need for rest, casts, braces, or other treatment. Help your child find activities and interests that don't involve a lot of movement or athletics.