Treatments and drugs

By Mayo Clinic Staff

As Legg-Calve-Perthes disease progresses, the ball part of the joint (femoral head) weakens and fractures — losing its nice round shape. The goal of treatment is to keep the femoral head as round as possible.

Surgery usually isn't needed for children younger than 6. They still have a lot of growing left to do so the femoral head has more time to repair the damage caused by Legg-Calve-Perthes. Most of this younger age group heal well with conservative treatments.

Therapy

If your child is younger than 6 or 7, your doctor may just recommend observation and symptomatic treatment with stretching, limited running and jumping, and medications as needed. Other nonsurgical treatments include:

  • Physical therapy. As the hip stiffens, the muscles and ligaments around it may shorten. Stretching exercises can help keep the hip more flexible and keep the hip in the socket.
  • Crutches. In some cases, your child may need to avoid bearing weight on the affected hip. Using crutches can help protect the joint.
  • Traction. If your child is in severe pain, a period of bed rest and traction may help. Traction involves a steady and gentle pulling force on your child's leg.
  • Casts. To keep the femoral head deep within its socket, your doctor may recommend a special type of leg cast that keeps both legs spread widely apart for four to six weeks. After this a night-time brace is sometimes used to maintain hip flexibility.

Surgery

Most of the orthopedic treatments for Legg-Calve-Perthes disease are aimed at improving the shape of the hip joint to prevent arthritis later in life.

  • Contracture release. Children who have Legg-Calve-Perthes often prefer to hold their leg across the body. This tends to shorten nearby muscles and tendons, which may cause the hip to pull inward (contracture). Surgery to lengthen these tissues may help restore the hip's flexibility.
  • Joint realignment. For children older than 6 to 8, realignment of the joint has been shown to restore a more normal shape to the hip joint. This involves making surgical cuts in the femur or pelvis to realign the joints. The bones are held in place with a plate while the bone heals.
  • Removal of excess bone or loose bodies. In older children with painful, restricted motion, trimming extra bone around the femoral head or repairing damaged cartilage may ease motion and relieve pain. Loose bits of bone or torn flaps of cartilage can be removed.
  • Joint replacement. Children who have had Legg-Calve-Perthes sometimes require hip replacement surgery later in life. These surgeries can be complicated because of a higher risk of bone fracture and nerve damage.
Jul. 17, 2012