Legg-Calv-Perthes Disease

What is Legg-Calv-Perthes Disease?

Legg-Calv-Perthes disease, also known as Perthes disease, is a childhood hip
disorder of unknown cause. It affects the ball part of the hip joint, called the femoral
head. The blood supply to the femoral head is interrupted for an unknown reason,
resulting in damage to the hip. Over a one to two year period, the bone slowly collapses
and is replaced with new bone.
This condition can cause hip joint pain and stiffness. Perthes disease tends to affect
only one hip in most children. A smaller group of children may get Perthes on the other
hip later in childhood. It is five times more common in boys than girls. The disease can
occur from ages two to fifteen, but is more common between ages four to eight. Early
diagnosis and treatment of Perthes disease can improve the long-term outcome.

Date of Origination:7/98
This material is for educational use. Questions and concerns
Date of Review: 9/13
should be discussed with your health care provider.
H:\\FCMAF\PATED\AMBCARE\AMB\AMB-062.DOCX

PATIENT EDUCATION: Amb Care

Readability: 7.2
PAGE 1 OF 2

Stages of Perthes Disease

a. Initial stage The femoral head blood supply is interrupted which causes the
bone to die (necrosis/osteonecrosis) and change shape.
b. Resorption/Fragmentation stage During this stage, the dead bone is
resorbed. The femoral head is weakened, becoming flattened or collapsed. This
stage can take one to two years.
c. Reossification stage - New bone slowly starts to fill in the areas where the dead
bone has been resorbed.
d. Healed stage Bone regrowth is complete, but the femoral head may not be its
original round shape. The age of the child disease at onset and the extent of the
femoral head collapse may affect the shape of the healed femoral head.

How is Perthes Disease Treated?

There are various treatment options for Perthes disease. No single treatment is
known to always restore the deformed femoral head to the original shape. The
current goal of treatment is to prevent the deformity before it happens.
Four factors determine which treatment is best:
Age of child at onset of the disease
Amount of the femoral head affected by Perthes
X-ray findings, such as stage of disease
Complying with the doctors treatment plan
Nonsurgical Treatments
Weight-relief of affected leg using crutches, walker or wheelchair
Reducing physical activity (It is important in fragmentation stage because
activities, such as long walks, running and jumping increase damage to the
femoral head)
Maintaining a healthy weight
Bracing and/or casting
Surgical Treatments
Pelvic osteotomy (Reshape the hip so the acetabulum can better cover the
femoral head)
Femoral osteotomy (Reshape the femur so the femoral head can be better
positioned in the acetabulum)
Casting, with or without tendon lengthening (tenotomy)

What are the goals of treatment?

Reduce pain
Improve hip movement
Prevent further collapse of the femoral head
Decrease the risk of having degenerative arthritis in the hip as an adult
You and your doctor will decide the best treatment plan for your child.
Date of Origination: 7/98
This material is for educational use. Questions and concerns
Date of Review: 9/13
should be discussed with your health care provider.
H:\\FCMAF\PATED\AMBCARE\AMB\AMB-062.DOCX

PATIENT EDUCATION: Amb Care

Readability: 7.2
PAGE 2 OF 2

Q&A for Perthes Disease

What causes Perthes disease?
The cause is unknown and the disease is not inherited in most patients. A very small
number of patients have another family member with Perthes.
Should I expect a lot of complaints of pain?
Pain generally suggests that there is hip joint inflammation, which can be caused by too
much activity. The amount of pain experienced by a child with Perthes disease varies
from patient to patient. Some patients complain of activity-related pain or night pain
only. Your child may complain of groin, thigh or knee pain. They may have restricted
movement and a mild limp. You and your childs doctor will discuss how to manage
pain.
What is the time frame of Perthes?
Perthes disease has four stages. In general, it may take three to five years for a patient
to go from the initial stage to the healed stage of the disease. The length of each stage
can vary.
What activities can my child do?
Your childs doctor will help you determine the activities that are safe. The answer will
depend on the stage of the disease, symptoms and hip joint stiffness.
What are long-term effects of Perthes disease?
Most children have occasional periods of increased pain and stiffness for six months to
two years. Most children will return to typical activities and sports once healed.
However, some children may be at risk for developing arthritis as adults. Childrens hips
that grow back irregularly will have more symptoms, such as pain and hip stiffness, and
a greater risk of arthritis later in life.
Will my child be able to participate in physical activities?
Even with a deformed femoral head, most patients can perform daily activities and
sports activities once the hip has healed.
Is hip replacement an option?
Hip replacement is not a surgery for children. Only when a patient develops painful
degenerative arthritis later in adulthood is the surgery recommended.

Date of Origination:7/98
This material is for educational use. Questions and concerns
Date of Review: 9/13
should be discussed with your health care provider.
H:\\FCMAF\PATED\AMBCARE\AMB\AMB-063.DOCX

PATIENT EDUCATION: Amb. Care

Readability: 7.2
PAGE 1 OF 1

Perthes Disease: Glossary of Terms

1. Acetabulum: The socket part of the hip joint.
2. Arthrogram: An arthrogram is a radiology procedure in which special X-ray
medicine is placed into the hip joint. This X-ray exam shows and evaluates the
shape of the ball part of hip joint (femoral head). It also assesses whether the
femoral head is covered (contained) by the socket part of the hip joint
(acetabulum). Most patients tolerate this procedure very well. A nurse will
monitor your child for pain management needs. Sedation is available if needed.
3. Femoral head: The ball part of the hip joint.
4. Leg length discrepancy: A difference in length between the two legs. In some
patients with Perthes disease, the affected leg can be shorter.
5. Necrosis: Refers to cell death in general; osteonecrosis refers to bone cell
death.
6. Ossification: This is a process of new bone formation.
7. Range of motion: Movement of a joint in all its directions. For example, hip
abduction is to move the leg out, away from the body.
8. Referred pain: This is pain starting from somewhere else but is perceived to
begin at that site. In Perthes disease, some patients complain of knee or thigh
pain instead of hip pain.
9. Resorption: Removal of dead bone by the body.
10. Tenotomy: Surgically lengthening or releasing a tendon that is tight to improve
hip joint motion. In some patients with Perthes disease, hip adductors or muscles
that bring the leg in (adduction), can get tight and prevent the leg from being
abducted (bring the leg out). If the abduction movement is lost, the hip adductors
may need a tenotomy.

Date of Origination:7/98
This material is for educational use. Questions and concerns
Date of Review: 5/12
should be discussed with your health care provider.
H:\\FCMAF\PATED\AMBCARE\AMB\AMB-064.DOCX

PATIENT EDUCATION: Amb. Care

Readability: 7.7
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