CLPD

Legg-Calve-Perthes

Disease

Wafer Aldulaimi / Denmark

The diseas was discovered in 1910 shortly after development of x-ray

Epidemiology 1/1200 /year

usually happens in young boys 5-7 years old (3-12) that are smaller in stature and that tend to be very active

Also seen in small active dogs

Pathoanatomy

Transient avascular necrosis of femoral head

Symptoms and signs

Limping

Pain in hip, groin or sometimes knee area

Stiffness

Decrease range of motion in hip

Leg length differentiation

Pain can vary depending on child, amount of physical activity and how long child goes without seeking professional help

some muscle spasms

Diagnosis

History , physical examination and plane x-rays

MR scanning not routinely

Stages

1. Necrosis : Femoral head appears smaller on x-rays

2. Fragmentation and femoral head collapse. (The pain and limp are worse during this stage)

3. Reossifiction: Healing phase starts when new bone formation begins. (The pain decreases)

4. Remodeling :The head is completely healed and the dead bone is now replaced with new bone

Treatment

Main goal is the keep the femoral head inside the socket of the hip

1. Symptomatic treatment and physiotherapy

2. Follow up: Pain and limp. Range of movement and x-rays

3. Containment by braces or casting ( No longer advocated ! )

4. Containment by surgery  

Femoral varus osteotomy

Pelvic osteotomy

Combined osteotomy

In case of Hinge abduction (lateral extrusion of the femoral head resulting in the femoral head impinging on the edge of the acetabulum with abduction)

An abduction-extension proximal femoral osteotomy should be considered

Most patients with LCPD do well until the fifth or sixth decade of life, at which time degenerative changes in the hip joint are common which may need THA