Legg-Calve-Perthes disease

Children’s Hospital Boston’s hip sub-specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care to children and young adults of all ages. How we’ll treat your child’s LCP depends on the complexity and severity of his condition—as well as his age, overall health, medical history and the expectations for the course of his condition as he grows.

If your child has LCP, he must avoid putting weight on the hip until after treatment. So he may need to use crutches or a wheelchair until he receives treatment, and we’ll work with you to set that up.

The goals of treatment for LCP are to:

• preserve the roundness of your child’s head of the thigh bone
• keep the head of the thigh bone in the socket (containment)
• prevent deformity while the condition runs its course
• regain hip motion
• eliminate pain that results from the tight muscles around the hip and the inflammation inside the joint

Treatment options depend on the degree of your child’s hip pain, stiffness, and x-ray changes over time—as well as how much of the head of the thigh bone has collapsed.

Non-surgical treatment
Non-surgical approaches to treatment may include:

• resting the joint (not bed rest)
• activity restrictions
• non-steroidal pain medication
• bed rest and traction
• casting or bracing to:
  • hold the head of the thigh bone in the hip socket
  • permit limited joint movement
  • allow the thigh bone to remold itself into a round shape
• physical therapy, to keep the hip muscles strong and promote hip movement
• crutches or wheelchair (in some cases)

Surgery
If these conservative treatments prove inadequate, your child may need surgery to hold the head of the thigh bone in the hip socket (containment). Surgery involves cutting and reorienting the affected bones (osteotomy), and stabilizing the realignment with screws and plates.

The two most important factors that determine the outcome are the child's age (usually, the younger the better) and how much of the head of the thigh bone is affected by the condition.

If your child needs surgery: care before and after

Before your child’s procedure, he must avoid putting weight on the hip until after treatment. He may be instructed to use crutches or a wheelchair until his surgery.

After surgery, your child will need to limit his weight-bearing by using crutches or a walker for about six to eight weeks. Physical therapy will help him restore his muscle strength.

Specialist care throughout your child’s growth period

Success rates are high for LCP treatment at Children’s. Even so, any child who’s been treated for a hip disorder should be followed periodically by his orthopedist until his skeletal growth is complete. Your doctor will monitor your child’s hip, since it needs to grow normally through his whole growth period in order to be durable for a lifetime.

The majority of surgical treatments for LCP at Children’s occur without major complications. But later in life, hip problems can recur, even after successful treatment in childhood. The more severe the case is, the greater the chance for limited hip motion, different leg lengths and arthritis. At Children’s, we follow many of our hip disease patients throughout their lives.

Coping and support

We at Children’s understand that a hospital visit can be difficult. So, we offer many amenities to make your child’s—and your own—hospital experience as pleasant as possible. Visit the Center for Families for all you need to know about:

• getting to Children’s
• accommodations
• navigating the hospital experience
• resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with Legg-Calvé-Perthes disease. Will my child need surgery? How long will his recovery take? Will it affect my child long term? What should we do at home? Children’s can help you connect with extensive resources to help you and your family through this stressful time, including:

• patient education: From doctor’s appointments to treatment to follow-up, our nurses and physical therapists will be on hand to walk you through your child’s diagnosis, surgery and recovery. And once your child is home, we’ll help you coordinate and continue the care and support he received at Children’s.
• parent-to-parent: Want to talk with someone whose child has been treated for Perthes? Our Orthopedic Center can often put you in touch with other families who’ve been through the same experience that you and your child are facing, as well as a Perthes Support Group.
• faith-based support: If you’re in need of spiritual support, we’ll connect you with the Children’s chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
• social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial issues.