Legg-Calvé-Perthes disease, also known as Perthes disease, is a rare most common disease in children ages 4 to 8 characterized by decreased blood flow in the hip region during a child’s development, mainly where bones are connected.the head of the leg bone, the femur.
Legg-Calvé-Perthes disease is self-limiting because the bone heals over time due to restoration of local blood flow, but can leave sequelae.In all cases, it is important that the diagnosis is made early to avoid bone deformities and increase the risk of hip arthritis in adulthood.
The most characteristic symptoms of Legg-Calvé-Perthes disease are
In most cases, these symptoms affect only one leg and one side of the hip, but there are few children where the disease can develop on both sides and therefore symptoms can appear in both legs, being called bilaterally.
In addition to evaluating a child’s symptoms and history, the pediatrician may also place the child in various positions to try to understand when the pain is most severe and thus identify the cause of hip pain.
The tests normally requested are x-rays, ultrasounds and scans, and MRI may be done to diagnose transient synovitis, bone tuberculosis, infectious or rheumatic arthritis, bone tumors, multiple epiphysical dysplasia, hypothyroidism, and Gaucher’s disease.
The main goal of treatment is to keep the hip focused and well-mobile throughout the disease process to avoid hip deformity.
This disease is considered self-limiting, improving spontaneously, however, it is important for the orthopedist to indicate the decrease or withdrawal of the patient’s hip stress activities and follow-up.To get around it is recommended that the person use crutches or the spine, which is an orthopedic device that keeps the lower limb affected, keeping the knee bent with a strap attached to the waist and ankle.
Physical therapy is indicated throughout the treatment of Legg-Calvé-Perthes disease, with sessions to improve leg movement, relieve pain, prevent muscle atrophy and avoid movement limitation.In more severe cases, in case of major changes in the femur, surgery may be recommended..
Treatment may vary depending on the child’s age, the degree of femoral head injury and the stage of the disease at the time of diagnosis. If there are major changes in the hip and head of the femur, it is very important that specific treatment is applied.introduce yourself to avoid complications in adulthood.
Thus, the treatment of Legg-Calvé-Perthes disease can be divided as follows:
Before age 4, bones are in a phase of growth and development, so most of the time they evolve to normal without any treatment being performed.
During these types of treatments, it is important to have regular consultations with the pediatrician and pediatric orthopedist to check if the bone is healing properly or if there is a worsening, being necessary to reassess the form of treatment.
Certain factors may influence the end outcome of treatment, such as sex, the age at which the diagnosis was made, the extent of the disease, the time of initiation of treatment, body weight, and whether there is hip mobility.
Generally, from the age of 4, the bones are already quite developed and with their almost definitive form, in these cases the pediatrician usually recommends surgery to realign the joint or remove excess bone that may exist in the head of the femur, for example by the scars left by the fractures.
In addition, in the most severe cases, where there was a deformity, it may be necessary to replace the hip joint with a prosthesis, in order to definitively end the problem and allow the child to develop properly and have a good quality of life..