Diagnosis and Treatment of Legg-Calvé-Perthes Disease

Diagnosis of Legg-Calvé-Perthes disease involves the use of many different imaging techniques including X-ray, bone scan, and magnetic resonance imaging (MRI). Physical measurements of the thigh muscles and exams to assess the kids’ range of motion are also performed as part of diagnosis of this condition.

Physical Examination

During the physical assessment, the doctor moves the patient’s legs into different positions to determine the range of motion and to check if any of the positions are painful.

Imaging Tests

X-rays

In the early stage, X rays may be normal as the damages caused by the condition take 1-2 months to show up on X rays. Hence several X-rays over a period of time are recommended to monitor disease progression.

Bone Scan

In a bone scan, a radioactive material is injected into a vein of the patient. The material travels specifically to bones that are damaged and are rebuilding themselves. Thus areas with such bones can be visualized in the scan images.

MRI

MRI uses a strong magnetic field and radio waves to create detailed images of bones and soft tissues in the body. MRIs can clearly show bone damage caused by the condition.

Treatment of Legg-Calves-Perthes Disease

The main goal of treatment is to bring the joint back to its normal, round shape as much as possible and restore hip mobility.

Crutches and Traction

Some kids with the condition may benefit from using crutches as it protects the joint by helping to avoid weight bearing by the affected leg. If a child experiences severe pain, bed rest and traction may be recommended. Traction is the use of a gentle but steady pulling force on the affected leg.

Casts

Doctors may also recommend casts to help keep the femoral head in the socket. A special leg cast is used in this condition and it keeps both legs wide apart for about 5 weeks, post which a night-time brace may be prescribed to boost flexibility of the hip.

Surgery

Orthopedic treatment methods for Legg-Calve-Perthes disease are mostly aimed at enhancing the shape of the femoral head and hence preventing arthritis in future. Different types of surgeries are performed including the following:

Joint Realignment

Older children have been shown to benefit from joint realignment as it helps restore the shape of the femoral head to a good extent. The surgery involves cutting the femur and realigning the joints. The bones are usually supported by a plate as they heal.

Contracture Release

Children affected by Legg-Calve-Perthes usually have short muscles and tendons around the hip, which cause the hip to pull inward. This contracture can be corrected by surgery that lengthens the tendons and muscles, thereby restoring the flexibility of the hip.

Excess Bone Removal

Older children having restricted and painful motion can get relief from trimming of the excess bone around the hip joint. Fixing damaged cartilage also helps in easing pain and improving motion.

Joint Replacement

Some children affected by this condition might need hip joint replacement when they get older. However, this surgery is very complicated and carries a high risk of nerve and bone damage.

Treatment in Young Children

Since children under the age of 6 years are still growing and their femoral head has time to rebuild, surgery is not usually needed. Kids of this age group respond well to traditional non-surgical treatment methods.

Doctors usually recommend physical therapy such as mild running and jumping, stretching exercises, and drugs in young children. Additionally, stretching helps keep the hip in position and make it more flexible.

Home Remedies

Some home remedies help in managing pain and preventing damage. They include avoiding too much activity such as running or jumping, taking OTC pain medications such as Tylenol, and using ice packs or hot packs to relieve hip pain caused by the condition.

References

http://emedicine.medscape.com/article/1248267-overview#a8
http://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/basics/tests-diagnosis/con-20035572
http://nonf.org/perthesbrochure/perthes-brochure.htm