Legg-Calve-Perthes Disease

Legg-Calve-Perthes disease (aka Perthes disease), or avascular necrosis of the femoral head, involves loss of blood supply (a- without vascular- blood vessel) to the proximal femoral epiphysis, the bony end-cap of the ball of the hip. It is a fairly common condition which has a peak incidence between 3 and 10 years of age. It affects males four times more often than females. For reasons which are not clear, the tiny vessels which supply the epiphysis become blocked or non-functional. The bone gradually dies, dissolves, and then over a period of 18-36 months is replaced by new bone.

The condition usually presents itself as pain and limp. The pain may be felt in the hip, the groin area, the anterior thigh, or often the knee. The pain is aggravated by activity, and gets better with rest. The child prefers not to bear weight on the affected side, and limps in such a way to keep weight off the affected hip. The hip exam may show limited range of motion about the affected hip compared to the other side. The thigh muscles may show atrophy on the affected side.

Treatment of this condition is problematic and controversial. In the past, long periods of bed rest have been prescribed. Imagine keeping a rambunctious three year old in bed for oh, a year and a half... Nowadays, various forms of bracing and surgery are the preferred approaches; this is a condition that would need attention by a pediatric orthopedic specialist.

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