Legg-Calvé-Perthes disease, also called Perthes disease, is a rare disease more common in male children aged between 4 and 8 years characterized by decreased blood flow in the hip region during child development, mainly where the bones connect with the head of the leg bone, the femur.
Legg-Calvé-Perthes disease is self-limiting, as the bone heals itself over time due to the restoration of local blood flow, but it can leave sequelae. In any case, it is important that the diagnosis is made early to avoid bone deformations and increase the risk of hip arthritis in adulthood.
Main symptoms
The most characteristic symptoms of Legg-Calvé-Perthes disease are:
- Difficulty walking; Constant hip pain, which can lead to physical disability; Acute and intense pain may be present, however this is rare, making early diagnosis difficult. Difficulty moving the leg; Limited range of motion with the leg.
In most cases, these symptoms only affect one leg and one side of the hip, but there are some children in whom the disease can manifest on both sides and, therefore, symptoms can appear on both legs, being called bilateral.
How to diagnose
In addition to assessing the child's symptoms and history, the pediatrician can also place the child in various positions to try to understand when the pain is most severe and thus identify the cause of the hip pain.
The tests normally requested are radiography, ultrasound and scintigraphy. In addition, magnetic resonance imaging can be performed in order to make the differential diagnosis for transient synovitis, bone tuberculosis, infectious or rheumatic arthritis, bone tumors, multiple epiphyseal dysplasia, hypothyroidism and Gaucher disease.
How the treatment is done
The main goal of treatment is to keep the hips centered and with good mobility 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 from the effort activities for the hip and perform the monitoring. To move, it is recommended that the person use crutches or the lanyard, which is an orthopedic device that holds the affected lower limb, keeping the knee flexed by means of a strap fixed to the waist and ankle.
Physiotherapy 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, when there are major changes in the femur, surgery may be recommended.
Treatment may vary according to the child's age, degree of damage to the head of the femur and 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 started to avoid complications in adulthood.
Thus, treatment for Legg-Calvé-Perthes disease can be divided as follows:
Children up to 4 years
Before the age of 4, the bones are in a phase of growth and development, so that most of the time they evolve to normal without any type of treatment being carried out.
During these types of treatment, it is important to have regular consultations with the pediatrician and with the pediatric orthopedist to check if the bone is healing correctly or if there is any worsening, being necessary to reassess the form of treatment.
Some factors can influence the final result of the treatment, such as sex, age at which the diagnosis was made, extent of the disease, time of treatment start, body weight and if there is hip mobility.
More than 4 years
Generally, after the age of 4 the bones are already quite developed and with their almost final shape. In these cases, the pediatrician usually recommends having surgery to realign the joint or remove the excess bone that may exist in the head of the femur, due to the scars left by the fractures, for example.
In addition, in the most severe cases, in which there was deformity, it may be necessary to replace the hip joint with a prosthesis, in order to permanently end the problem and allow the child to develop correctly and have a good quality of life..
