I am still catching up with this challenge. I am going backward today and doing ‘L’ after I finished ‘M’. It just seemed easier for me. The subject for the letter ‘L’ is Legg-Calve-Perthes Disease (LCPD). The disease was first described over 100 years ago and was named after three orthopedic surgeons: Arthur Legg (1874-1939), American, Jacques Calve (1875-1954), French and Georg Perthes, German.
Legg-Calve-Perthes Disease is considered a rare disease. It occurs in five to ten in one hundred thousand children under the age of fifteen. They are most commonly between the ages of four to eight, but it can occur in children from two to fifteen and affects boys more often than girls. Usually LCPD is found in one hip, but both hips may be affected. These children may be very physically active and small for their age. The most troubling long-term problem with this disorder is that it may cause a permanent deformity of the femoral head and that would increase the risk of developing osteoarthritis in the child’s adult years.
This childhood hip disorder occurs because the blood that flows to the head of the femur is lost. This causes cellular death of the bone, called (Avascular Necrosis). As a result, the femoral head is no longer round and is no longer able to move easily in the hip socket. The child will begin to have hip pain, limping, and restricted leg movement. When the blood begins to flow properly again, the bone begins a healing process, known as Bone Remodeling, where the old bone is removed and new bone replaces it. During this time, the femur is soft and may easily fracture and collapse. The femoral hear heals in an abnormal shape and does not fit into the hop socket properly causing stiffness and pain. This cycle of breakdown and healing can recur multiple times. The younger the child is, the better the chances for the hip joint healing in a normal round shape. The cause of LCPD is not known.
If the child is younger than six, the doctor may recommend observation and treating the symptoms with stretching, limited exercise, and medications when needed. They may order physical therapy with stretching exercises to help keep the hip flexible and in the socket. To avoid bearing weight on the affected hip, he may order crutches. If the child is in severe pain, he may have him on bedrest and traction for a time. A special type of leg cast that keeps both legs spread widely apart for four to six weeks may be necessary.
There are different surgeries that can be done usually if the child is over seven years old:
1. Contracture release – It is common for children with LCPD to prefer holding their leg across the body. This may cause a shortening of the nearby muscles and tendons, which could cause the hip to pull inward (contracture). In this case a surgery too lengthen the tissues may be necessary to restore the hip’s flexibility.
2. Joint realignment – If the child is older than six to eight, this has been known to restore a more normal shape to the hip joint. This involves surgical incisions in the femur or pelvis to realign the joints. The bones are then held in place with a plate during the time that the bone is healing.
3. Removal of excess bone or loose bodies – Older children with pain and difficulty moving the affected leg would require cutting the extra bone around the femoral head or repairing the damaged cartilage could ease motion and relieve pain.
4. Joint replacement – Hip replacement surgery may be necessary later in life for children with LCPD. For them the the surgery could be complicated because of a high risk of bone fracture and nerve damage.
Legg-Calve-Perthes Disease is not a chronic disease, but could be the cause of some problems later such as, early osteoarthritis, shortened limb, and chronic pain.
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