Legg-Calvé-Perthes Disease Private Treatment
Legg-Calvé-Perthes disease often referred as simply Perthes disease is a rare condition that affects the hip in children, leading to pain and mobility issues. Understanding and treating this disease early can significantly improve outcomes and quality of life for affected children. If you are concerned about your child’s hip health, consider consulting a private paediatric orthopaedic consultant for specialised care.
What is Perthes Disease?
Perthes disease is a rare childhood condition that is caused by a temporary loss of blood supply to the femoral head, the ball part of the hip joint. Without sufficient blood flow, the bone cells begin to die, a process known as avascular necrosis. Over time, the body replaces the dead bone with new bone, a process that occurs in complex stages over the course of several years. This may lead to significant hip problems if not managed properly.
There are four stages in Perthes disease:
Initial Phase: In this stage, the blood supply to the femoral head is interrupted and causes bone cells to die. The hip generally becomes inflamed and irritated and symptoms may become apparent, such as a limp or pain in the groin, thigh or knee. This stage can last several months.
Fragmentation: The body starts to replace the dead bone with initially softer bone. This causes the ball of the femoral head to be in a weaker state which may result it to become a flatter shape. On X-ray the top of the femoral head (epiphysis) may appear in pieces or fragmented.
Reossification: The softer bone is then replaced by stronger bone. This can take several years.
Remodelling / Healed: The bony replacement / regrowth has finished and the femoral head’s final shape has been determined. The shape of the femoral head is determined by how much fragmentation has occurred during the second phase and also the age of the child which how much regrowth can occur.
Perthes Disease Signs and Symptoms
Identifying Perthes disease early is crucial for effective treatment. Common signs and symptoms include:
Limping: One of the earliest signs is a noticeable limp, which can be intermittent.
Hip or Groin Pain: Pain can also be felt in the thigh or knee.
Reduced Range of Motion: The affected hip may not move as freely or as far as the other hip.
Muscle Atrophy: Thigh muscles on the affected side may appear smaller due to disuse.
Stiffness and Inflammation: The hip may feel stiff and inflamed, particularly after physical activity.
Is Perthes Disease Painful?
Yes, Perthes disease can be painful, especially during the initial stages when the bone begins to die and the hip joint becomes inflamed. Pain may vary in intensity and can be intermittent. Children might complain of pain after activities or at the end of the day.
How is Perthes Disease Diagnosed?
Diagnosis typically involves a combination of physical examination and imaging studies:
Physical Examination: The paediatric orthopaedic surgeon will check for signs of limping, pain, and reduced hip mobility.
X-rays: These are used to visualise the condition of the femoral head and assess the extent of bone damage. 2 different views (AP and Frog Lateral) are important in making the diagnosis.
MRI Scan: These can provide more detailed images of the hip and help in early detection when X-rays are inconclusive.
What Causes Perthes Disease?
The exact cause of Perthes disease remains unknown. It is believed to result from a temporary reduction in blood flow to the femoral head, but why this happens is still unclear. Potential contributing factors include:
Genetics: Family history may play a role.
Trauma: Injury to the hip may contribute to disrupted blood flow.
Blood Clotting Disorders: Conditions that affect blood clotting could impact blood supply to the hip.
Environmental Factors: Factors like passive smoking may also contribute.
Can You Grow Out of Perthes Disease?
Children can recover from Perthes disease as the bone heals and reshapes itself over time. However, the process can take several years, and the quality of recovery depends on various factors, including the child's age at onset and the severity of the disease.
At What Age Does Perthes Disease Usually Occur?
Perthes disease typically affects children between the ages of 4 and 10 but can also affect toddlers in rare cases. It is most common in boys (5x), though girls can also be affected. The average age of onset is around 6 years old. In 10-15% of all cases, both hips are affected but at different times.
At What Age Should Perthes Disease Be Treated?
Early treatment is crucial, ideally starting soon after diagnosis. Younger children tend to have a better prognosis because their bones are still growing and can remodel more effectively. Treatment should begin as soon as the condition is identified to prevent long-term damage.
Can Children Be Cured of Perthes Disease?
While there is no "cure" for Perthes, effective management can lead to significant improvement and even complete recovery. The goal is to ensure that the femoral head remains as round as possible to fit properly in the hip socket.
What is the Treatment for Perthes Disease?
Treatment varies depending on the child's age and the severity of the condition. The goal of treatment is to relieve the painful symptoms, protect the femoral head shape and maintain as much hip movement as possible. There are many factors that affect what treatment may be given and the paediatric orthopaedic surgeon will formulate a bespoke treatment plan for your child.
Common approaches include:
Rest and Activity Modification: Reducing impact activities that put stress on the hip. This will help relieve any pain and also protect the femoral head. In severe cases, crutches or even a wheelchair may be recommended
Physical Therapy: Exercises to maintain hip mobility and strength. These will concentrate on hip abduction and hip rotation.
Medications: Pain relief and anti-inflammatory drugs.
Casting: To keep the femoral head in the hip socket. A broomstick case which holds the leg apart (abduction) may be applied to help keep the femoral head in the cup (acetabulum) of the hip joint.
Surgery: In severe cases, surgical intervention might be necessary. An arthrogram (dye test of the hip joint) may be performed to help decide on further treatment. If required, surgery may be performed to reshape the hip joint. This may include a cut in the thigh bone (femoral osteotomy) or the pelvis (salter pelvic osteotomy) followed by a period in cast (hip spica).
What are the Long-Term Effects of Perthes Disease?
In the majority of cases, the prognosis from Perthes disease in good and do not have any further hip problems into adulthood. However, long-term effects can vary. Some children recover completely, while others may have lasting issues if the femoral head does not fit well into the hip joint This can include:
Hip Stiffness: Reduced range of motion.
Osteoarthritis: Increased risk of arthritis in adulthood.
Leg Length Discrepancy: One leg may become shorter than the other.
Why Consider Private Treatment for Perthes Disease?
Time
Faster Treatment: By opting for private care, your child can receive treatment often before an NHS appointment becomes available.
Convenient Scheduling: Private treatment offers more flexible appointment times to fit around your busy schedule, minimising disruption to your family life.
Quality
Enhanced Facilities: Private hospitals often have better-equipped facilities and luxuries not typically available in NHS settings.
Comfort
Comfort: Private treatment includes facilities like better food choices, private bathrooms, homely rooms, air conditioning, and smart TVs, making the hospital stay more pleasant.
Convenient Consultations: You can book consultations directly with our paediatric orthopaedic surgeon, ensuring you have easy access to medical advice and support.
Attention
Personalised Care: With fewer time pressures on staff, private treatment allows for more in-depth consultations, providing more time to talk and receive personalised care tailored to your child's needs.
More Choice
Flexibility: You can choose the location of the hospital, the specific specialist, and the timing of appointments, giving you greater control over your child's treatment journey.
If you suspect your child might have Perthes disease, seeking early intervention and specialised care is crucial. For expert advice and personalised treatment plans, consider booking an appointment with a private paediatric orthopaedic consultant.
AUTHOR:
Stephen Ng Man Sun is a Paediatric Orthopaedic Consultant at Chelsea and Westminster Hospital, London. He has been a consultant since 2019 and is a fellowship trained Paediatric Orthopaedic Surgeon. You can read more about Mr Ng Man Sun on our About Page or connect with him in LinkedIn / Twitter.