Bone, Joint and Muscle Conditions
What is Legg-Calvé-Perthes disease?
Legg-Calvé-Perthes disease (LEG-cal-VAY-PER-theez) is a problem in the hip. It is often called Perthes disease.
Legg-Calvé-Perthes disease occurs when blood temporarily stops flowing to the ball (femoral head) at the top of the thighbone that fits into the hip socket. If the bone does not get enough blood, it dies. The bone collapses and becomes flat. As a result, the ball no longer moves smoothly in the hip socket.
Over the course of several months, the blood supply comes back to the bone. New bone cells gradually replace the dead bone. This process may take 2 or 3 years.
The disease can occur in both hips, but usually not at the same time.
Children with Legg-Calvé-Perthes disease may develop arthritis early and lose some movement in their hips.
Legg-Calvé-Perthes disease in children
Although any child can get Perthes disease, boys with the disease outnumber girls 4 to 1. Usually, they are thin, wiry, very active boys who are smaller than others their age.
Perthes disease usually develops when children are between the ages of 4 and 8. But children as young as age 2 and as old as age 12 can develop the disease.
Legg-Calvé-Perthes Disease at Seattle Children’s
We have decades of experience treating children with Legg-Calvé-Perthes disease. Doctors at Seattle Children's developed the Staheli shelf procedure, a surgical technique used internationally to treat older children with Perthes disease. The procedure is named after the former director of our Department of Orthopedics, Dr. Lynn T. Staheli.
In this operation, doctors add a shelf of bone to the outer part of the socket to deepen it. This way, it can better hold the ball (femoral head) at the top of the thighbone. This helps prevent some of the deformity of the ball that can occur with Perthes disease.
We see your child as a whole person. Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. Here, your child’s team has special training in the medical, surgical, emotional and social needs of young people.
Complex conditions that affect your child’s bones, muscles and joints may affect other parts of their body too, from their nerves or lungs to their bladder. We connect you with the many types of Seattle Children’s experts your child needs – on the same day, in the same clinic whenever we can.
To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods (like medicines, physical therapy and braces), recommending surgery only when we believe it will give your child the best results.
We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.
Many of our pediatric orthopedic surgeons have expanded fellowship training in areas such as:
- Foot and ankle conditions
- Sports medicine
- Upper extremity surgery
- Limb differences
- Neuromuscular diseases
- Skeletal dysplasia
- Spine problems
Symptoms of Legg-Calvé-Perthes Disease
Children with Perthes disease often have a slight limp. Other symptoms include:
- Pain in the knee, thigh or groin
- Stiffness in the hip
- Limited range of motion in the hip
- Upper thigh muscles get smaller
- Legs appear to be different lengths
Diagnosing Legg-Calvé-Perthes Disease
Doctors look for a slight limp in your child’s walk, a common sign of Perthes disease. They also ask questions about any pain your child might be feeling. Then they examine your child.
The doctor will gently move your child’s legs, comparing the movement on the sore side with the movement on the other side.
Doctors may take X-rays to make sure Perthes disease is the problem. If the X-rays look normal, they may ask for a bone scan or an MRI (magnetic resonance imaging) so they can get more information.
Treatment Options for Legg-Calvé-Perthes Disease
For many years, doctors researching Legg-Calvé-Perthes disease have been looking for the best way to keep the femoral head working in the hip socket.
Using medicines and reducing activity to decrease pain seem to work the best in children younger than 6 years old. Sometimes doctors use a brace to slow a child down in an effort to decrease pain and improve movement of the hip.
Surgery for Legg-Calvé-Perthes disease
Children who are older than 6 years or who have more severe cases of Perthes disease are more likely to benefit from surgery. The goal of surgery is to prevent the dislocation or collapse of the hip. That is, to keep the femoral head in your child’s hip socket.
These surgeries either tilt the ball so it is deeper in the socket or rotate the socket so that it will cover the ball better when your child walks. Sometimes doctors try to do both.
If you have questions about Legg-Calvé-Perthes disease treatment, call our Orthopedics and Sports Medicine Department at 206-987-2109. If you would like an appointment, ask your child’s primary care provider for a referral.
Providers, see how to refer a patient (PDF).