Legg-Calve-Perthes Disease (LCPD)

is a

degenerative disease of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket. The disease is characterized by idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head leading to an interruption of the blood supply of the head of the femur close to the hip joint. One or both hips may be affected. The disease is typically found in young children common among boys 2-12 years old, and it can lead to osteoarthritis in adults. The effects of the disease can sometimes continue into adulthood. It is named for Arthur Legg, Jacques Calv and Georg Perthes.

Other names

Coxa plana Calve-Perthes disease Legg-Perthes disease Avascular necrosis of the femoral head Osteochondritis juvenilis

Causes Idiopathic Genetics Hormonal predisposition Trauma Thyroid deficiency Infection

Anatomy and physiology

Femoral head - The femur head (Latin: caput femoris) is the highest part of the thigh bone (femur). It is supported by the neck of the femur. The head is globular and smooth, coated with cartilage in the fresh state. Femoral neck - The femur neck or neck of the femur is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft. Cartilage - is a flexible connective tissue found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs. It is not as hard and rigid as bone but is stiffer and less flexible than muscle. Obturator artery - The obturator artery is a branch of the internal iliac artery that passes anteroinferiorly (forwards and downwards) on the lateral wall of the pelvis, to the upper part of the obturator foramen, and, escaping from the pelvic cavity through the obturator canal, it divides into both an anterior and a posterior branch. Lateral femoral circumflex artery - is an artery in the upper thigh.

Medial femoral circumflex artery - is an artery in the upper thigh that helps supply blood to the neck of the femur. Pathophysiology Inadequate blood supply to the femoral head (Bone infarction)

Deterioration of femoral head

Dying bone cells replaced with new cells

Unstable bone Breaks easily Heals poorly Femur collapses and becomes flat (mushroom)

Clinical Manifestations a. Synovitis causing limp ang pain and pain in the hips. (intermittent or lasts for several months). b. Referred pain to the knee, inner thigh and groin, usually with activity. c. Decreased ROM, particularly with internal rotation and abduction. d. Atrophy of thigh muscles secondary to disuse. e. Muscle spasm. f. Leg length inequality due to collapse (dislocation).

g. Short stature due to delayed bone growth due to bone infarction. h. (+) roll test

Diagnostic procedures a. Physical examination b. X-ray c. MRI d. Bone scan e. Arthrogram Management Goals: a. To maintain normal shape of femoral head as possible. b. To protect hip from further stress and injury. c. To keep the ball of femur in the hip socket. 1. Restoration of motion

For initial relief of synovitis, muscle spasm and joint pain. Administration of antiinflammatory medications for joint inflammation. Decrease dosage as the hip begins to heal. Ibuprofen. NO ASPIRIN Limitation of activities, bed rest with or without activity modification. Contraindication: prolonged bed rest. ROM exercises to maintain joint mobility. Can be done at home or with the help of physical therapist. Ease pain by keeping the childs weight off his hip.

2. Physical therapy

3. Crutches

4. Casts, braces or traction Temporary immobilizes the bone leading to healing. Leg of hip casts, leg braces and tractions Replacement of femur in the acetabulum.

5. Surgery