Legg-Calve-Perthes Disease/Perthe’s Disease/ Osteochondrosis of the Femoral Capital Epiphysis
Aseptic necrosis/osteochondroses of neck and proximal epiphysis of femur – femoral head becomes flattened. Most commonly ages 2 – 12 (usually 4-9). M>F. More common than 1 in 1000 children.
Cause unknown. Associated with changes in vascular supply and venous drainage; coagulation abnormalities have been demonstrated; children tend to be shorter; higher proportion of children with ADHD develop it (? role of trauma).
Characterised by ischaemic necrosis, collapse and subsequent repair. 85% present with limp and hip/groin pain. 15% have referred pain to knee – probably from obturator nerve involvement. Usually unilateral (up to 8% bilateral). Have some limitation of rotation and abduction (flexion usually normal) – may have atrophy of thigh muscles.
Usually resolves in 2-3 years- with rest, avoidance of aggravating activities, brace to maintain abduction and internal rotation all aimed to reduce force on hip ( frustration of child in not able to participate in sport & other activities).
Physiotherapy for restoration and maintenance of movement.
Rarely need surgery (eg proximal femoral varus osteotomy)
Better prognosis in younger child. Increased risk for long term osteoarthritis.
Transient Synovitis of the Hip
Buschke disease | Calcaneal Apophysitis | Diaz (Mouchet’s) Disease | Distal Tibial Epiphysitis | Freiberg's Disease | Iselins Disease | Kohler's Disease | Legg-Calve-Perthes Disease | Osgood-Schlatter Disease | Osteochondrosis of Os navicularis | Severs Disease | Thiemann’s Disease | Treves’ or Ilfeld’s Disease