Name
LEGG-CALVE-PERTHES DISEASE
DESCRIPTION
DETAIL
CAUSES β’ Etiology unclear β’ Related to interruption of blood flow to femoral epiphysis -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Unilateral - septic arthritis, toxic synovitis, juvenile rheumatoid arthritis β’ Bilateral - spondyloepiphyseal dysplasia, metaphyseal dysplasia, hypothyroidismLABORATORY β’ CBC β’ Sedimentation rate (elevated in infection) IMAGING β’ Serial radiographs, AP and frog lateral, of the pelvis are crucial for determining of extent of involvement and progression of healing. β’ Full extent of involvement may not be evident for several months as radiographic findings lag symptoms β’ MRI - Most sensitive test; facilitates early diagnosis of necrosis and visualization of articular surface β’ Dynamic arthrography - used to assess congruency of femoral head β’ Technetium 99 bone scan - may be helpful in delineating the extent of avascular changes DIAGNOSTIC PROCEDURES Hip aspiration to rule out septic arthritis
TYPENOTES
RISK FACTORS: No genetic risk factors, Increased incidence in children with low birth weight and delayed physical maturationAPPROPRIATE HEALTH CARE . A pediatric orthopaedic consultation . Ambulatory treatment is usual, however, some patients may require inpatient traction or surgical procedures GENERAL MEASURES . Goals of treatment: . Relieve weight bearing across affected hip, thus reducing irritability of the hip . Obtain and maintain hip range of motion . Maximize regeneration and spherical development of the femoral head by containing the femoral epiphysis within the acetabulum SURGICAL MEASURES . Adductor tenotomy to help restore range of motion secondary to adductor contracture . Femoral and/or pelvic osteotomy to help contain femoral epiphysis within the confi nes of the acetabulum (in older children or in cases of hip subluxation) ACTIVITY . Ambulatory status depends on extent/stage of disease . Limit weight bearing in cases of hip irritation DIET No special diet PATIENT EDUCATION . Legg-Calve-Perthes disease is a self-limited disease with revascularization occurring within 3 years . Treatment is directed at maintaining an appropriate range of motion and maximizing the containment of the femoral head DRUG(S) OF CHOICE β’ Ibuprofen 10 mg/kg tid-qid PATIENT MONITORING β’ Initially, close followup, with radiographic evaluation, is needed to determine extent of necrosis β’ Once healing phase entered, followup can be every 6 months β’ Long-term followup necessary to determine final outcome PREVENTION/AVOIDANCE Since etiology is not clearly understood, prevention is not possible POSSIBLE COMPLICATIONS β’ Permanent distortion of the femoral head β’ Distorted joint susceptible to early degenerative joint disease EXPECTED COURSE/PROGNOSIS β’ Most patients have a favorable outcome β’ Outcome is dependent on the patientβs age at the time of the diagnosis (the younger the better) β’ Prognosis is also related to the degree of involvement of the femoral head (as determined by radiography)
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY HIP JOINT A.P. AND LAT. VIEW, BONE SCAN, COMPLETE BLOOD COUNT, MRI