What is Coxa Plana?

Legg-Calve-Perthes disease; Perthes disease Is a degenerative disease of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket. The disease is characterized by idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head leading to an interruption of the blood supply of the head of the femur close to the hip joint. Risk Factors Occurs most frequently in boys 3 to 12 years old. Caucasians are affected more frequently than other races Males are affected 3-4 times more often than females Causes Although no-one has identified the cause of Perthes disease it is known that there is a reduction in blood flow to the joint. It is thought that the artery of the ligamentum teres femoris closes too early,

not allowing time for the medial circumflex femoral artery to take over. For example, a child may be 6 years old chronologically but may have grown to 4 years old in terms of bone maturity. The child may then engage in activity appropriate for a child of 6 but may not yet have the bone strength of an older child, leading to flattening or fracture of the hip joint.

Symptoms Knee pain (may be the only symptom, initially) Persistent thigh or groin pain Atrophy (wasting) of muscles in the upper thigh Slight shortening of the leg, or legs of unequal length Hip stiffness restricting movement in the hip Difficulty walking, walking with a limp (which is often painless) Limited range of motion Diagnostic Test X-rays Bone scans Magnetic Resonance Imaging (MRI) Arthrograms a diagnostic imaging test to study the non-bony structures of joints.

Blood tests Erythrocyte sedimentation rate elevated if infection present Treatment The aim of treatment is to protect the bone and joint from further stress and injury while the healing process takes place. rest activity restrictions medications bed rest and traction casting or bracing (to hold the femoral head in the hip socket, permit limited joint movement, and allow the femur to remold itself into a round shape again) physical therapy (to keep the hip muscles strong and to promote hip movement) crutches or wheelchair (in some cases) Surgery surgery (to hold the femoral head in the hip socket) Inominate osteotomy; varus osteotomy; osteotomy of the proximal femur, acetabulum (Salter innominate), or a combination of these may be required Other than surgery; NSAIDs such as Motrin help with the pain inflicted.

Phases of Perthes Disease Phase 1: Necrosis - Blood supply is absent to the femoral head and the hip joint becomes inflamed, stiff, and painful. Portions of the bone turn into dead tissue. The ball of the thigh bone becomes less round in appearance on x-rays. This phase can last from several months up to one year. Phase 2: Fragmentation - The body cleans up the dead bone cells and replaces them with new, healthier bone cells. The femoral head begins to remodel into a round shape again. The joint is still irritated and painful. This phase can last from one to three years. Phase 3: Reossification - The femoral head continues to model itself back into a round shape with new bone. This phase lasts for one to three years. Phase 4: Remodeling Normal bone cells replace the new bone cells and the remodeling continues. This last phase can last a few years to complete the healing process.

Complications Osteoarthritis may develop later in life, although the development of osteoarthritis may be minimized with prompt recognition and proper treatment. Prognosis The outcome is usually good with treatment. Most bone will heal with minimal lasting deformity. Children younger than 6 have the best prognosis since they have time for the dead bone to revascularize and remodel. Children that have been diagnosed with Perthes' Disease after the age of 10 are at a very high risk of developing osteoarthritis