Legg Calve Perthes (LCPD)

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. The disease is typically found in young
children, and it can lead to osteoarthritis in adults. The effects of
the disease can sometimes continue into adulthood.
Also known as:
Perthes disease
Ischemic necrosis of the hip
o!a plana
"steochondritis
#ascular necrosis of the femoral head
Causes$
The e!act cause is unknown
%eduction 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 medical circumfle!
femoral artery to take over
&bnormal blood clotting
Infection
'alnourishment
(enetic
Trauma
Incidence
Perthes is rare, occurring in appro!imately ).) of *++,+++ children.
Signs & Symtoms$
,irst -igns$
complaint of sourness from the child .often dismissed
as growing pain/
limping
guarding of the joint
"ther -ymptoms$
hip, knee .reffered pain/, or groin pain, e!acerbated
by hip/leg movement.
%educe %"' at the hip joint and a painful or antalgic
gait
&trophy of thigh muscles from disuse
Ine0uality of the leg length.
Pathohysiology
Predisposing/ %isk factors$
"besity
,amily history
1ow birth weight
&bnormal presentation at birth
%ace2 &sians, 3skimos, whites
(enetic, Infection, Trauma, 'alnutrition, &bnormal 4lood lotting,
Idiopathic.
%apid (rowth 5 6evelopment of the -upply of the -econdary "ssification
enters in the 3piphysis.
Interrupted of ade0uate blood flow
Prone to avascular necrosis
%esult in necrosis
6eformity of the ball of the hip, knee or groin
pain
femur and the surface of the
hip socket
1imping, guarding of
the joint
ine0uality of leg length
antalgic gait
6isuse
&trophy thigh muscles
!our Stages o" LCPD
1. ,emoral head becomes more dense with possible fracture
of supporting bone7
2. ,ragmentation and reabsorption of bone7
3. %eossification when new bone has regrown7 and
4. 8ealing, when new bone reshapes.
Phase I takes about 92: months, Phase : takes one year or
more, and Phase ; and < may go on for many years.
Diagnosis:
=2%ay
'agnetic %esonance Imaging .'%I/
bone scan
#reatment
The goal of treatment is four2fold$
I/ to reduce hip irritability
:/ restore and maintain hip mobility
;/ to prevent the ball from e!truding or collapsing
</ to regain a spherical femoral head
$edical $%#$
>-&I6 .'otrin) ? for pain
@oledponic &cid .under investigation/
Surgical $%#:
-urgery is indicated for children greater that age 9 years.
3!cision of e!truded portion of the head for hinge abduction
&cetabular osteotomy
1ateral shelf osteotomy
hiari osteotomy
#algus osteotomy
&rthrodesis
&on'surgical treatment:
cast
traction
braces
Prevention
There is no known effective preventative measure
&ursing $%#:
6istraction method ? for pain
&dvice refrains from contacts sports or game/activities which
impact the pain.
%eneral Interventions:
1. Instruct patient to report pain as soon as it begins
2. Provide 0uite environment, calm activities.
3. 3ncourage use of diversional activity .T#, %adio,
socializing/
4. 3ncourage ade0uate rest periods to prevent fatigue
evaluate in pain behavior
&ursing D(:
&cute pain related to inflammation of joint secondary to legg
calve perthes disease.
Impaired physical mobility related to abnormal gait secondary
to legg calve perthes disease.
%isk for injury related to altered mobility secondary to
unsteady gait.
Avascular &ecrosis
Is a disease resulting from the temporary or permanent loss
of the blood supply to the bone. Aithout blood, the bone tissue dies
and causes the bone to collapse. If the process involves the bones
near a joint, it often leads to collapse of the joint surface.
Also known as:
"steonecrosis
&septic necrosis
Ischemic bone necrosis
)tiologies$
&lcohol abuse
aisson .decompression/ disease
igarette smoking
,at emboli
(out
%adiation therapy
%aynauld phenomenon
-ickle cell disease with increase blood viscosity
-ystemic steroids
Trauma, such as fracture, disruption circulation in the bone
Bnknown cause, known as idiopathic &#>
Causes$
,ollowing is a list of causes or underlying conditions .see also
'isdiagnosis of underlying causes of &vascular necrosis/ that could
possibly cause &vascular necrosis includes$
Traumatic injury
,racture
6islocation
6islocated hip .see 8ip symptoms/
&lcoholism
3!cessive alcohol
Pathohysiology
%isk factors$
injury
steroid use
(aucher disease
alcohol use
blood disorders, such as sickle cell anemia
radiation treatments
chemotherapy
pancreatitis
decompression disease
Traumatic causes non2traumatic causes
Temporary or permanent loss of blood supply to the bone
Ahen blood supply is cut off, the bone tissue dies
minimal early joint pain
4one collapses
increased joint pain as bone and joint begin to collapse
If it occurs near a joint, collapse of the joint surface may occur
limited range of motion due to pain
Diagnostic #ests
The list of diagnostic tests mentioned in various sources as used
in the diagnosis of &vascular necrosis includes$
=2rays
'%I 2 good for diagnosis in the early stages
4one scintigraphy .bone scan/
T scan
4one biopsy
#reatments "or Avascular necrosis
The list of treatments mentioned in various sources for &vascular
necrosis includes the following list. &lways seek professional medical
advice about any treatment or change in treatment plans.
>-&I6s 2 for pain
&void weight bearing 2 take pressure off the joint .e.g.
crutches/7 in some cases this allows the body to self2heal.
%ange2of2motion e!ercises
3lectrical stimulation 2 to stimulate natural growth of the
bone.
&void alcohol
Treat alcoholism 2 if the problem is caused by alcoholism.
6iscontinue corticosteroid use 2 slowly under medical advice,
since stopping 0uickly causes problems.
-urgical treatments
o ore decompression
o "steotomy
o 4one graft
o Coint replacement .arthroplasty/
&ursing D(:
Impair physical mobility related to &#> of femoral head or
tarsal navicular bone.
&cute pain related to ischemic changes and degeneration of
involved bone.