Legg-Calvé-Perthes disease

• Juvenile osteochondrosis of hip and pelvis

• 732.1 Juvenile osteochondrosis of hip and pelvis

• M91.1 Juvenile osteochondrosis of head of femur

• 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Bony or Soft Tissue Surgery1

Description

• Impairment of blood flow to the hip resulting in destructive changes
• Self-limiting disease of the hip

Essentials of Diagnosis

• Age of onset or detection is best predictor of successful recovery

General Considerations

• Four stages
  • 1. Condensation: bone stops and femoral head becomes necrotic
  • 2. Fragmentation of necrotic bone; femoral head and acetabulum become deformed; revascularization begins
  • 3. Reossification of femoral head
  • 4. Remodeling of femoral head and acetabulum

Demographics

• Children aged 3 to 13 years old, especially males aged 5 to 7 years old
• Males 3 to 5 times more likely than females
• Usually unilateral; bilateral 10-20% of the time
• Uncommon in African Americans

Signs and Symptoms

• Pain
• Antalgic gait
• Trendelenburg gait
• Referred pain to groin, thigh, knee
• May have limited hip internal rotation, abduction, extension
• Muscle spasm of hip flexors and adductors

Functional Implications

• Difficulty with ambulation, stairs
• Limited hip mobility
• Antalgic gait

Possible Contributing Causes

• Avascular necrosis of hip (i.e., lack of blood flow to the capital femoral epiphysis) due to
  • Injury
  • Infection
  • Vascular anomalies (congenital or acquired)
  • Thrombus
  • Synovitis

Differential Diagnosis

• Infection
• Dysplasia
• Synovitis
• Gaucher’s disease
• Sickle cell anemia

Imaging

• X-ray of hip to evaluate for avascular necrosis

• To orthopedic surgeon for
  • Anti-inflammatory medication
  • Traction
  • Orthotic prescription
    • Petrie cast2
    • Scottish-Rite brace3
    • Surgical repair including osteotomy

• Referred pain from hip
• Muscle spasms of hip flexors and adductors
• Gait deviations
• Decreased mobility due to pain and partial weight-bearing with crutches
• Decreased hip internal rotation, abduction, extension ROM

• For when patient released by physician for physical therapy after casting or surgical repair
• Modalities to decrease pain
• AROM and PROM of hip
• Strengthening of hip
  • Hip abduction in standing or sidelying
  • Hip extension in standing or prone
    • Bridges
  • Sit-to-stand exercises
  • Wall squats
• Gait training

• The patient will be able to
  • Increase hip AROM and PROM for internal rotation, abduction, extension
  • Increase strength of hip musculature, especially hip extensors and abductors
  • Ambulate 150 feet independently with crutches, non-weight bearing on involved leg
  • Ambulate independently without gait deviations or gait aides for 500 feet

• Children under 8 years of age with least involvement of femoral head have best outcomes, as bone has time to reshape
• Children with complete involvement of femoral ...