Legg-Calve-Perthes syndrome (LCPS) is a condition that involves the bones of the hip joint. The upper part of the thigh bone (femur) is in the shape of a round ball called the femoral head. This ‘ball’ fits into a socket in the pelvis bone. LCPS occurs when there is not enough blood delivered to the femoral head.
Blood is needed to deliver oxygen and nutrients to the bones. Without adequate blood supply, the femoral head goes through a process of degradation (crumbling) and repair. The hip also becomes irritated. This causes limping and hip pain. Over time, the femoral head will heal itself and become more rounded. However, in some children, it does not get back its original shape.
The cause of LCPS is unknown. It is most common in children ages four to eight, and it is four times more common in boys than girls. Both hips are involved in about 10% of children. LCPS is more common in active children and children who are small for their age. In some cases there may be a family history.
Diagnosis can usually be made by taking an x-ray, which will show femoral head changes. However, additional tests such as MRI and bone scan can be useful in making the diagnosis, especially during the earliest phase of the disease. Additional testing may be necessary to rule out other conditions such as infection or childhood arthritis.
A limp is the most common sign of LCPS. Many children with this condition have hip pain that worsens on days they are very active and may improve with rest. Some children with LCPS notice knee or thigh pain. The motion of the affected hip is often less on the opposite side.
The goal of treatment is to keep the hip joint from getting stiff and to lessen pain. The type of treatment often depends on the age of the child, how the hips move and how the hips look on x-ray. Types of non-operative treatment may include:
- Rest or activity modification
- Pain medications, such as ibuprofen or acetaminophen
- Physical therapy
In the past, physicians frequently prescribed braces that kept the legs apart to treat LCPS. However, these braces are not used as often because recent research has shown they are only effective in certain situations.
Some children require surgery to help the hip develop into a more 'normal' shape. There are many different surgical procedures available; your child’s surgeon can discuss this further if your child needs surgery. In some children with severe LCPS, surgery to correct deformities of the bone is required after the disease has run its course.
Generally, LCPS symptoms are present for about 18 months to two years old. Children with LCPS have an increased risk of hip arthritis. However, most patients with LCPS are active and have minimal or no pain 20 to 30 years after their diagnosis.
The long-term prognosis for children with LCPS depends on the shape of the femoral head and how it fits into the socket once the condition has run its course. Children who are younger when they are diagnosed with LCPS tend to have better outcomes.