Legg-Calve-Perthes disease

From greek.doctor
  • Legg-Calve-Perthes disease = Perthes disease = idiopathic avascular necrosis of the femoral head
  • Epidemiology
    • 3 – 16 years
    • Boys > girls
  • Etiology: Idiopathic by definition
  • Pathomechanism
    • The femoral epiphysis grows quickly and is therefore highly dependent on adequate blood supply
    • Inadequate blood supply can be due to compression of the arteries (for example from transient coxitis)
  • Clinical features
    • Usually unilateral
    • Antalgic gait
    • Pain in groin, thigh, or knee
    • Limited internal rotation and abduction
  • Diagnosis
    • X-ray
      • Often shows nothing the first 3 – 6 months
      • Shows flat, collapsed femoral head
    • MRI
      • If x-ray is negative but clinical suspicion persists
  • Treatment
    • The primary aim of treatment of Perthes disease is containment (= holding the femoral head in the acetabulum)
      • Can be achieved by conservative therapies or by surgery
    • Conservative
      • Non-weightbearing activities
        • To allow re-ossification
        • Swimming is excellent
      • Pain management
      • Physical therapy
    • Surgical
      • Generally only for children > 8 years
        • Younger children generally don’t benefit from surgery
      • Surgical containment by femoral or pelvic osteotomy
  • Complications
    • The younger the patient, the better prognosis
    • Heals in 3 – 5 years
    • May lead to late osteoarthritis (Perthes is a prearthritic condition)