Legg-Calve Perthes Disease
Overview:
Legg-Calve´-Perthes (LCPD) disease is secondary to osteonecrosis of the proximal femoral epiphysis. Numerous vascular causes have been proposed but the exact etiology is largely unknown.1
Pathogenesis:
The pathogenesis is thought to involve bone necrosis. Some studies have shown that when the blood supply to the femoral head was interrupted by a single event, there was a failure to reproduce the characteristic lesion of LCPD. If fact other researchers have suggested that LCPD occurs over time with repetitive injury. With this necrosis of the femoral head, there is also a collapse of the bone and a repair which can lead to: A painless limp, hip pain with decreased abduction and internal rotation.2
Causes/Risk Factors:
Some of the causes of LCPD:3
Risk Factors:
Clinical Presentation:
The typical age for the onset of LCPD is 4-10 years with the condition being more present in boys than girls, who are often small of their age group. The patient may present with a limp that has lasted for weeks or months. The pain in from the injury can be referredt o different areas because of the innervatoin of the hip. Pain can be referred to the suprapatellar region, medial thigh, or the buttock. Some of the most consistent findings are limited internal rotation and abduction. 2
Contraindications/Precautions:
Physical therapy management of LCPD will vary depending on the treatment that the patients primary physician has set, and the physical therapist should follow the physicians recommendations.
Differential Diagnosis:
The clinician should differentiate LCPD from musculoskeletal or nervous impairments. If anything other than these two are expected the clinican should referr out to the proper healthcare professional.
Outcome Measures:
Some of the most common outcome measures that are used in the management of LCPD are:
Clinical Bottom Line:
LCPD is a necrosis of the femoral head within the hip joint, and can be the cause of hip, groin, or knee pain, along with the loss of hip ROM. Proper tests should be ran to differentiate this impairment from other possible musculoskeletal or nervous problems. If the clinician should suspect the patient to have LCPD, the prompt and proper referral should be made to their primary physician.
See the LCPD References
Legg-Calve´-Perthes (LCPD) disease is secondary to osteonecrosis of the proximal femoral epiphysis. Numerous vascular causes have been proposed but the exact etiology is largely unknown.1
Pathogenesis:
The pathogenesis is thought to involve bone necrosis. Some studies have shown that when the blood supply to the femoral head was interrupted by a single event, there was a failure to reproduce the characteristic lesion of LCPD. If fact other researchers have suggested that LCPD occurs over time with repetitive injury. With this necrosis of the femoral head, there is also a collapse of the bone and a repair which can lead to: A painless limp, hip pain with decreased abduction and internal rotation.2
Causes/Risk Factors:
Some of the causes of LCPD:3
- Idiopathic
- Possible causative factors include thrombophilia, trauma, hyperviscosity, venous congestion, and transient synovitis
- Biomechanical contributors may include acetabular retroversion
- Mutation in the gene responsible for type II collagen has been linked to LCPD
Risk Factors:
- Atypical birth presentation (breech), low birth weights, postponement of skeletal maturity, advanced parental age, family history of LCPD, lower socioeconomic status, child higher up in birth order, and living in urban communities have all been linked to an increased incidence of LCPD 4
- A nationwide study in Norway found that children with LCPD were significantly shorter at birth when compared to control subjects 5
- Children infected with HIV may have an increased risk for LCPD 6
Clinical Presentation:
The typical age for the onset of LCPD is 4-10 years with the condition being more present in boys than girls, who are often small of their age group. The patient may present with a limp that has lasted for weeks or months. The pain in from the injury can be referredt o different areas because of the innervatoin of the hip. Pain can be referred to the suprapatellar region, medial thigh, or the buttock. Some of the most consistent findings are limited internal rotation and abduction. 2
Contraindications/Precautions:
Physical therapy management of LCPD will vary depending on the treatment that the patients primary physician has set, and the physical therapist should follow the physicians recommendations.
Differential Diagnosis:
The clinician should differentiate LCPD from musculoskeletal or nervous impairments. If anything other than these two are expected the clinican should referr out to the proper healthcare professional.
Outcome Measures:
Some of the most common outcome measures that are used in the management of LCPD are:
- Goinometry
- VAS
- Gait assessment
- Balance testing
- MMT, if age appropriate
- Patient satisfaction surveys
- QOL measures
- Functional Mobility Scale
Clinical Bottom Line:
LCPD is a necrosis of the femoral head within the hip joint, and can be the cause of hip, groin, or knee pain, along with the loss of hip ROM. Proper tests should be ran to differentiate this impairment from other possible musculoskeletal or nervous problems. If the clinician should suspect the patient to have LCPD, the prompt and proper referral should be made to their primary physician.
See the LCPD References