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Legg Calve Perthes Disease

  • We've had the 100th anniversary year of the first recognition of Legg-Calve-Perthes disease. Dr. Arthur Legg, who in 1910 was one of the first describers of the condition, was a Boston Children's orthopedic surgeon. So, we have a long history and vast experience treating children with this condition.

    –Young-Jo Kim, MD, PhD, orthopedic surgeon, Boston Children's Hospital

    If your child has been diagnosed with Legg-Calvé-Perthes disease, you probably have many concerns and questions about his health, treatment, recovery and other issues. It may comfort you to know that Children’s Hospital Boston is a world leader in pediatric orthopedics and we have a wealth of experience helping children with this rare condition. We specialize in innovative, family-centered care that supports your child and family every step of the way.

    About Legg-Calvé-Perthes disease

    • Legg-Calvé-Perthes disease (also called LCP or Perthes disease) is a temporary hip condition in which the ball-shaped head of the thigh bone (femoral head) loses its blood supply (avascular necrosis). As a result, the head of the thigh bone collapses, and the area becomes inflamed and irritated.
    • Legg-Calvé-Perthes disease causes the hip joint to become painful and stiff for a period of time that varies from child to child. Your child may limp, with or without pain.
    • Affected children are usually:
      • between 4 and 10 years old
      • very physically active
      • small for their age
    • During the course of the condition, in the acute phase which can last two years or longer, the body absorbs the dead bone cells and replaces them with new bone cells. The new bone cells eventually reshape the head of the thigh bone (femur), but the result can be a deformation that can cause arthritis later on.
    • If signs and symptoms develop late (when the child is more than 6 years old), the condition is likely to be more serious, with a greater chance of a deformed joint that’s vulnerable to premature arthritis.
    • Proper non-surgical or surgical treatment during the course of the disease helps to alleviate your child's pain and make sure his hip retains its normal shape and range of motion.
    • Early diagnosis and treatment of severe cases help to avert the worst effects of arthritis.
    • The majority of cases affect one hip; 10 to 12 percent of cases affect both hips, but not usually at the same time.
    • The condition is rare—affecting about one in every 12,000 children.

    How Boston Children's Hospital approaches Legg-Calvé-Perthes disease and other developmental hip conditions

    Boston Children's orthopedic surgeon Arthur Thornton Legg, MD, one of the doctors after whom the condition is named, first recognized and described Legg-Calvé-Perthes disease in 1910. Since then, Children’s surgeons have built up a vast body of knowledge of, and experience with, Legg-Calvé-Perthes disease; we’ve pioneered advanced techniques for re-shaping the femoral head and optimizing joint function and longevity.

    Today, an important aspect of treating Legg-Calvé-Perthes disease is diagnosing the condition early in childhood. Early diagnosis and treatment allow as much time as possible for the head of your child's thigh bone to remodel itself back into a round shape, since children’s softer bones heal quickly and have a good capacity for self-repair. Treatment goals include controlling pain, maintaining hip motion and preventing additional hip deformity.

    Other developmental hip conditions


    Whatever hip treatment your child requires, you can have peace of mind knowing that, as national and international orthopedics referral centers, Boston Children’s Orthopedic Center and Child and Adult Hip Preservation Program have deep experience treating children with every kind of hip condition, some of which few other pediatric hospitals have ever encountered. As a result, we can provide expert diagnosis, treatment and care for every level of complexity and severity of hip problem.

    Unique expertise in treating adolescents with hip problems

    Many adolescents and young adults with hip problems need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program is the only such program of its kind. We offer the extensive experience and the most advanced techniques, with clinicians and researchers who are dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Leaders in Bernese periacetabular osteotomy (Bernese PAO)


    At Boston Children's, we’ve performed more than 1,400 Bernese PAOs since 1991 to correct hip dysplasia in teens and adults. Our large volume makes us the most experienced center in the United States for this procedure—and the second-most experienced in the world. The Bernese PAO—the most powerful procedure for repositioning the hip socket—is Children’s standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing (typically children ages 13 and older).

    One of the first programs

    Our Orthopedic Center is one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more 6,000 procedures each year. Our program, consistently ranked among the top in the country by U.S.News & World Report, is the nation’s preeminent care center for children and young adults with developmental, congenital, post-traumatic and neuromuscular problems of the musculoskeletal system.

    Legg-Calvé-Perthes disease: Reviewed by Young-Jo Kim, MD, PhD
    © Boston Children's Hospital, 2011

    Contact us

    Orthopedic Center
    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • Right now, you probably have lots of questions: How serious is Legg-Calvé-Perthes disease? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Boston Children’s Hospital can explain your child’s condition fully when you meet with us.

    Background: the normal hip joint

    The hip joint is one of the body's most reliable structures, providing most people with movement and support without pain or problems for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear.

    The well-fitting surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

    What is Legg-Calvé-Perthes disease?

    Legg-Calvé-Perthes disease (also known as LCP or Perthes disease) is a temporary condition in children in which the ball-shaped head of the thigh bone (femoral head) loses its blood supply. As a result, the head of the thigh bone collapses, and the area becomes inflamed and irritated.

    As the condition runs its course, the body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the head of the thigh bone, but the result can be a deformation that can cause arthritis later on.

    What are the stages of Perthes?

    Legg-Calvé-Perthes disease goes through four phases of changes that affect the head of the thigh bone: 

    • Phase 1, necrosis:The blood supply to the head (ball) of the thigh bone is interrupted, so the hip joint becomes inflamed, stiff and painful. Portions of the bone turn into dead tissue (avascular necrosis). The ball of the thigh bone becomes less round in appearance on x-rays. This phase can last from several months up to one year.
       
    • Phase 2, fragmentation:The body “cleans up” the dead bone cells and replaces them with new, healthier bone cells. The head of the thigh bone begins to remodel into a round shape again. The joint is still irritated and painful. This phase can last from one to three years.
       
    • Phase 3, reossification:The head of the thigh bone continues to model itself back into a round shape with new bone. This phase lasts for one to three years.
       
    • Phase 4, remodeling:Normal bone cells replace the new bone cells and the remodeling continues. To complete the healing process, this phase can last a few years.

    What causes Legg-Calvé-Perthes disease?

    LCP is idiopathic, which means that there is no known cause for the disease.

    Who’s affected by/at risk for Perthes?

    • Boys are five times more likely to be affected than girls (but girls’ cases can be more severe).
    • Affected children are usually:
      • between 4 and 10 years old
      • very physically active
      • small for their age
    • The condition tends to be more common in children who’ve been exposed to second-hand smoke.

    What are the signs and symptoms of Legg-Calvé-Perthes disease?

    Some signs and symptoms can include:

    • pain in the hip that’s aggravated during activity
    • pain in the thigh or knee area
    • walking with a limp (can be a “painless limp”)
    • pain that goes away with rest

    How common is LCP?

    Legg-Calvé-Perthes disease occurs in about one out of every 12,000 children.

    How serious is LCP?

    Perthes is a self-limiting disease, meaning that it eventually corrects itself by forming new, healthy bone in the place of dead bone. But the condition can leave the hip deformed and vulnerable to arthritis later in life. If the condition develops before a child is 6 years old, the hip’s self-correcting capability is very good. If Perthes develops later (after age 6), the condition can have more serious consequences.

    How does a doctor diagnose Perthes?

    In addition to a complete medical history and physical exam, a doctor’s tools for diagnosing LCP may include:

    • x-rays (chief diagnostic tool)
    • MRI (magnetic resonance imaging) (picks up early stages better than x-ray)
    • blood tests (to rule out infection)

    How does Boston Children’s treat Legg-Calvé-Perthes disease?

    The goals of treatment for LCP are to:

    • preserve the roundness of the head of the thigh bone
    • prevent deformity while the condition runs its course

    Treatment may include:

    • rest
    • activity restrictions
    • non-steroidal pain medication
    • bed rest and traction
    • casting or bracing
    • physical therapy
    • crutches or wheelchair (in some cases)
    • surgery (osteotomy, osteoplasty)

    My child’s LCP is mild. Does he still need treatment?

    Even for mild cases of Perthes, treatment is usually recommended in order to prevent additional deformity of your child’s joint. If his condition is mild, conservative treatments such as rest, activity restrictions and pain medication may be all that’s needed as the condition runs its course.

    If my child needs surgery, what will that entail?

    If 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.

    Will my child be OK?

    The majority of children treated for LCP at Children’s have corrections that enable them to walk, play, grow and live active lives. Diagnosing and treating your child’s Perthes early in its development greatly increase the likelihood of a successful outcome.

    The two most important factors that determine the outcome are:

    • your child's age at onset (usually, the younger the better)
    • how much of the head of the thigh bone is affected by the condition

    The more severe his case is, the greater the chance for the child’s hip motion to become limited and for him to have further hip problems in the future.

    What new research is Boston Children’s doing regarding developmental hip conditions?

    Developmental hip conditions such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis and hip dysplasia can lead to premature arthritis in young adults with resulting pain and disability. Children’s many research studies focus on understanding the mechanical forces (pathomechanics) that adversely change the hip’s structure and function. With better understanding, we can improve existing therapies and develop new therapies for these conditions.

    The clinical and basic science researchers at Boston Children’s Orthopedic Center are recognized throughout the world for their achievements in the field. Our breakthroughs mean that we can provide your child with the most innovative care available.


    FAQ

    Q: What is Legg-Calvé-Perthes disease?
    A:
    Legg-Calvé-Perthes disease (also called LCP or Perthes) is a temporary condition in children in which the ball-shaped head of the thighbone, referred to as the femoral head, loses its blood supply. As a result, the head of the thigh bone collapses, and the area becomes inflamed and irritated.

    As the condition runs its course, the body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the head of the thigh bone, but the result can be a deformation that can cause arthritis later on.

    Q: If my child has LCP, will he be OK?
    A:
    The majority of children treated for Perthes at Boston Children’s have corrections that enable them to walk, play, grow and live active lives. Diagnosing and treating your child’s condition early in its development greatly increase the likelihood of a successful outcome.

    The two most critical factors that determine the outcome are the child's age at onset (usually, the younger the better) and how much of the head of the thigh bone is affected by the condition. The more severe his case is, the greater the chance for the child’s hip motion to become limited and for him to have further hip problems in the future.

    If my child needs surgery, what will that entail?

    If 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.

    Q: How long will it take for my child to heal?

    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.

    Q: What are the signs and symptoms of Legg-Calvé-Perthes disease?
    A:
    Some signs and symptoms, which usually appear between the ages of 4 and 10, can include:

    • pain in the hip that’s aggravated during activity
    • pain in the thigh or knee area
    • walking with a limp (can be a “painless limp”)
    • pain that goes away with rest

    Q: How does Boston Children’s treat Perthes?
    A:
    Treatment may include:

    • rest
    • activity restrictions
    • non-steroidal pain medication
    • bed rest and traction
    • casting or bracing
    • physical therapy
    • crutches or wheelchair (in some cases)
    • surgery (osteotomy, osteoplasty)

    Q: If my child has LCP, what should I ask my Boston Children's doctor?
    A:
    Some of the questions you may want to ask include:

    • Could you describe what’s wrong with my child’s hip joint? How serious is his case?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to his tissues or blood vessels?
    • Does my child need treatment? Does he need surgery?
    • Will LCP affect his growth plate and/or the normal growth of his leg?
    • How long will it take for him to heal?
    • Will he need to use crutches? If so, when, and for how long?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Could there be long-term effects? Pain? Arthritis?
    • For how long should my child be followed by his care team?
    • What can we do at home?

    Q: How is Perthes usually diagnosed?
    A:
    In addition to a complete medical history and physical exam, the doctor’s tools for diagnosing LCP may include:

    • x-rays (chief diagnostic tool)
    • MRI (magnetic resonance imaging) (picks up early stages better than x-ray)
    • blood tests (to rule out infection)

    Q: If my child has LCP in one hip, will he develop it in the other hip, too?
    A:
    For the majority of children with LCP, only one hip is ever affected; in 10 to12 percent of children with the condition, both hips are affected, but not usually at the same time.

    Q: What are the causes and risk factors for Legg-Calvé-Perthes disease?
    A:
    LCP is idiopathic, which means that there is no known cause for the disease. What we do know is that:

    • Boys are five times more likely to be affected than girls (but girls’ cases can be more severe).
    • Affected children are usually:
      • between 4 and 10 years old
      • very physically active
      • small for their age
    • The condition tends to be more common in children who’ve been exposed to second-hand smoke.

    Q: What’s the long-term outlook for a child who has LCP?
    A:
    The majority of children treated for Legg-Calvé-Perthes disease at Children’s have corrections that enable them to walk, play, grow and live active lives. Diagnosing and treating your child’s LCP early in its development greatly increase the likelihood of a successful outcome.

    The two most critical factors that determine the outcome are the child's age at onset (usually, the younger the better) and how much of the head of the thigh bone is affected by the condition. The more severe his case is, the greater the chance for the child’s hip motion to become limited and for him to have further hip problems in the future.

    Q: What is Boston Children’s experience treating hip problems in children?
    A:
    At Boston Children’s, we’re known for our clinical innovations, breakthrough research and leadership in treatment for Perthes and other hip problems. We offer the most advanced diagnostics and treatments—several of which were pioneered and developed by Boston Children’s own researchers and clinicians.

    Causes

    LCP is idiopathic, which means that there is no known cause for the disease. But we do know that:

    • Boys are five times more likely to be affected than girls (but girls’ cases can be more severe).
    • Affected children are usually:
      • between 4 and 10 years old
      • very physically active
      • small for their age
    • The condition tends to be more common in children who’ve been exposed to second-hand smoke.

    Signs and symptoms

    Some signs and symptoms of Legg-Calvé-Perthes disease can include:

    • pain in the hip that’s aggravated during activity
    • pain in the thigh or knee area
    • walking with a limp (can be a “painless limp”)
    • pain that goes away with rest

    When to seek medical advice

    Contact your child’s doctor if your child:

    • has pain in his hip that’s aggravated during activity
    • has pain in the thigh or knee area
    • is walking with a limp (can be a “painless limp”)
    • has pain that goes away with rest

    Questions to ask your doctor

    If your child is diagnosed with Legg-Calvé-Perthes disease, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns get addressed.

    Some of the questions you may want to ask include:

    • Could you describe what’s wrong with my child’s hip joint? How serious is his case?
    • Are other tests needed to confirm this diagnosis?
    • Is there, or could there be, damage to his tissues or blood vessels?
    • Does my child need treatment? Does he need surgery?
    • Will LCP affect his growth plate and/or the normal growth of his leg?
    • How long will it take for him to heal?
    • Will he need to use crutches? If so, when, and for how long?
    • Will he need rehab or physical therapy?
    • Will there be restrictions on my child’s activities? If so, for how long?
    • Could there be long-term effects? Pain? Arthritis?
    • For how long should my child be followed by his care team?
    • What can we do at home?

    Who’s at risk

    While the exact cause of Legg-Calvé-Perthes disease is unknown (idiopathic), we do know that certain factors increase the risk for this condition:

    • Boys are five times more likely to be affected than girls (but girls’ cases can be more severe).
    • Affected children are usually:
      • between 4 and 10 years old
      • very physically active
      • small for their age
    • The condition tends to be more common in children who’ve been exposed to second-hand smoke.

    Complications

    The vast majority of surgical treatments for Legg-Calvé-Perthes disease at Boston Children’s occur without major complications. But patients who’ve had surgery for LCP are at a very small risk for infection, bleeding or poor bone healing (malunion).

    Long-term outlook

    Boston Children’s extensive research into bone problems means that we can provide your child with the most innovative care available. As a result, the majority of children treated for Legg-Calvé-Perthes disease at Children’s have corrections that enable them to walk, play, grow and live active lives.

    Diagnosing and treating your child’s LCP early in its development greatly increase the likelihood of a successful outcome.

    The two most critical factors that determine the outcome are the child's age at onset (usually, the younger the better) and how much of the head of the thigh bone is affected by the condition. The more severe his case is, the greater the chance for your child’s hip motion to become limited and for him to have further hip problems in the future, including premature arthritis.

    Legg-Calvé-Perthes disease glossary

    • acetabulum: hip socket; a part of the pelvis
    • arthritis (osteoarthritis): joint damage, resulting in pain, swelling, stiffness and limited movement. Arthritis can occur when a joint’s cushioning cartilage wears away.
    • arthrogram (MRI arthrogram): a two-part imaging study that’s useful for studying the non-bony structures of the joint
    • avascular necrosis (osteonecrosis): a condition in which poor blood supply to a bone leads to bone death; the head of the femur is a common site of this condition
    • The Center for Families at Boston Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care
    • cartilage: smooth, rubbery tissue that cushions the bones of a joint and other areas; allows the bones to move easily without pain
    • containment: in orthopedics, surgery to hold the head of the thigh bone in the hip socket
    • diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
    • femoral head: round-headed top of the thigh bone (femur)
    • femur: the thigh bone, the longest and strongest of your child’s bones. The rounded top of the femur (femoral head) joins the hip socket (acetabulum) to form the hip joint.
    • Legg-Calvé-Perthes disease (LCP, Perthes): a temporary condition in children in which the ball-shaped head of the thigh bone (femoral head) loses its blood supply. As a result, the head of the thigh bone collapses, and the area becomes inflamed and irritated.

    As the condition runs its course, the body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the head of the thigh bone, but the result can be a deformation that can cause arthritis later on.

    • malunion: poor bone healing after surgery that involves cutting a bone
    • MRI (magnetic resonance imaging): a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body
    • onset (of signs or symptoms): the first appearance of signs or symptoms
    • open reduction surgery: a procedure in which the doctor repositions the hip bone into the socket through an incision in the patient’s body (see osteoplasty below)
    • orthopedic surgeon, orthopedist: a doctor who specializes in surgical and non-surgical treatment of the skeletal system, spine and associated muscles, joints and ligaments
    • orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
    • osteonecrosis (avascular necrosis): the death of a bone due to loss of blood supply
    • osteoplasty, osteotomy: surgical procedures that involve cutting and reshaping bone
    • physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
    • thigh bone: common term for the femur, the longest and strongest bone in the body
    • x-rays: a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.

    Unique expertise in problems of the adolescent hip

    Many teens and young adults with hip problems need diagnostic and surgical techniques that are significantly different from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program is dedicated to finding better ways to care for adolescents and young adults with hip problems. 

    Our complete orthopedic team

    Children’s is the primary pediatric teaching hospital of Harvard Medical School, where our physicians hold faculty appointments. We’re the largest pediatric orthopedic center in the nation, with 13 specialty clinics; an onsite brace shop; a plaster room; and a clinical team of orthopedic surgeons, orthopedic residents and fellows, certified physician assistants, nurse practitioners, registered nurses, physical/occupational therapists, brace technicians and cast technicians.

    Boston Children’s Teen Advisory Committee

    To help teenagers take a more proactive role in their treatment and to have their needs recognized, Boston Children’s developed the Teen Advisory Committee. The group—made up of current Boston Children’s patients, ages 14 to 21—serves as a team of peers who can listen to other patients’ needs, ensure their voices are heard.

  • At Boston Children's Hospital, we know that the first step to treating your child’s Legg-Calvé-Perthes disease is to form a complete and accurate diagnosis.

    Our goal is to diagnose Perthes as early as possible in order to prevent continuing hip deformity. If your child receives a diagnosis of LCP, he must avoid putting weight on the hip until after treatment. He may be instructed to use crutches or a wheelchair until he receives treatment.

    In addition to a complete medical history and physical examination, diagnostic procedures for LCP may include:

    • x-rays: (chief diagnostic tool)
    • MRI (magnetic resonance imaging): picks up early stages better than x-ray
    • blood tests: to rule out infection
  • Boston Children's Hospital'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 Boston 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 Boston 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 Boston Children's, we follow many of our hip disease patients throughout their lives.

    Coping and support

    We at Boston 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 Boston 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 Boston 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.

    A long line of orthopedic firsts

    With a long history of excellence and innovation and a team of clinicians and researchers at the forefront of orthopedic research and care, Boston Children's is home to many orthopedic breakthroughs, including:

    • a hip program that has performed more than 1,400 Bernese periacetabular osteotomies
    • one of the first scoliosis clinics in the nation
    • advances in our Spinal Program, such as video-assisted thorascopic surgery
    • advanced techniques and microsurgery care for complex fractures and soft tissue injuries to the hand and upper extremity

      Boston Children's also is:

    • the oldest and largest comprehensive center for the care of spina bifida
    • one of the first pediatric sports medicine clinics in the nation
    • one of the first centers in the nation to use adjuvant chemotherapy and perform limb salvage surgery for patients with Osteosarcoma
    The Experience Journal

    Designed by Boston Children's psychiatrist-in-chief David DeMaso, MD, and members of his team, the Experience Journal is an online collection of thoughts, reflections and advice from kids, parents and other caregivers about a variety of medical experiences, including hip problems.

  • For more than a century, orthopedic surgeons and investigators at Children’s Hospital Boston have played a vital role in advancing the field of musculoskeletal research. We’ve developed breakthrough treatments and major advances for developmental hip problems such as LCP, as well as scoliosis, polio, tuberculosis and traumas to the hand and upper extremities.

    Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—to provide children with the most innovative care available.

    In Boston Children’s Orthopedic Center and Child and Adult Hip Preservation Program, we take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their achievements. Our orthopedic research team includes:

    • full-time basic scientists
    • 28 clinical investigators
    • a team of research coordinators and statisticians

    Studies of developmental hip conditions

    Developmental hip conditions such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis and hip dysplasia can lead to premature arthritis in young adults with resultant pain and disability. Our research focuses on understanding the pathomechanics (mechanical forces that adversely change the body's structure and function) of these conditions. With better understanding, we can improve existing therapies and develop new therapies for these complex conditions.

    Current and recent studies include the following:

    • We’re studying perfusion MRI as a predictor for developing avascular necrosis after closed reduction of dislocated hips: Our retrospective analysis is looking at predictive values of contrast-enhanced MRI after closed reduction for avascular necrosis (cellular death due to interrupted blood supply) in patients with developmental dysplasia of the hip. 
    • We’re conducting many ongoing studies to follow patients who’ve been treated for hip dysplasia and slipped capital femoral epiphysis (SCFE). Our studies use outcomes measures, custom questionnaires and special methods for measuring results—both prospectively (before treatment) and retrospectively.

    For example, a very common hip condition called femoral acetabular impingement (FAI) is a research topic that Children’s is working on extensively. FAI is a frequent cause of osteoarthritis of the hip. FAI is a jamming that occurs in some hips, resulting in damage to the cartilage. The most common cause of FAI is a “bump” on the neck of the femur that remains as a result of SCFE. The impingement can be small (causing minor damage) or larger (accumulating damage to the cartilage inside the hip and resulting in arthritis). In a long-term study, our researchers are investigating the effectiveness of removing the bump at the time of surgery.

    • We’re studying long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia: Since 1991, Children's has performed more than 1,400 Bernese periacetabular osteotomies to correct hip dysplasia in teens and adults, whose hip sockets have finished growing. This large volume makes Children’s the most experienced center in the United States for this procedure—and the second-most experienced in the world.

      PAO is our standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing—typically teens ages 13 and older—and whose hip is still viable enough to be repaired rather than replaced. The procedure rotates the hip socket into a more stable position and is the most complex and powerful procedure for positioning the hip socket.

      We’re constantly obtaining and analyzing radiographic and clinical long-term follow-up data on sub-groups of our PAO patient population as it ages, to determine the effectiveness of the procedure for halting or preventing the development of osteoarthritis of the hip.
    • We’re studying the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early osteoarthritis in dysplastic hips: In early osteoarthritis, the charge of the extracellular matrix is degraded and lost. The delayed gadolinium-enhanced MRI of cartilage technique is designed to indirectly measure the early loss of charge density in cartilage. 
    • Children’s is a founding member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR), a collaboration of researchers dedicated to following patients with developmental hip disease. ANCHOR now comprises 10 centers in the United States and one in Europe, and enrolls more than 500 patients each year in various studies.

    Orthopedic basic science laboratories

    Working in Boston Children’s labs are some of the leading musculoskeletal researchers in the nation. Our labs include:

    Children speak about what it's like to be a medical research subject

    View a video of a day in the life of Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science. 

    Boston Children's Hip Program's unique insight and expertise

    Boston Children’s Child and Adult Hip Preservation Program enjoys a special degree of effectiveness—not just because of our long tradition of excellence in pediatric hip care, but also because we follow our patients through adulthood. This gives us a unique perspective, insight and expertise—we can track how the hip works in each age group, how the problems evolve, and how the hip’s function changes over time in adult patients who’ve had treatment in childhood.

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