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Legg-Calvé-Perthes - Hip Dysplasia - Slipped Capital Femoral Epiphysis

Multidisciplinary treatment for hip disorders


Legg-Calvé-Perthes Disease and Other Hip Disorders

Pediatric hip disorders can take many forms. Chief among them is Legg-Calvé-Perthes disease, or Perthes disease; a condition that restricts blood flow to the thighbone's ball-shaped head, also known as the femoral head. This results in a collapse of the femoral head and absorption of the bone by the body. New bone eventually replaces the old, but the previous rounded shape of the bone no longer exists. Other hip disorders affect this crucial hip joint in different ways, calling for unique treatment approaches that lend themselves to healing, adjustment and recovery.

Legg-Calvé-Perthes disease is a childhood bone disorder that typically only affects one hip, although roughly 10 percent of children experience it in both hips. Symptoms tend to appear between the ages of 4 and 8, and boys are four times more likely to get Perthes disease.

When blood stops flowing to the femoral head, it begins breaking down and losing its round shape, making it difficult to fit and move in the hip socket as it should. This, in turn, impacts mobility, causes pain, and can lead to early onset osteoarthritis.

Four stages of Legg-Calvé-Perthes disease

  1. Initial: Sometimes called the necrosis stage, this phase of Perthes disease can last several months and is marked by disrupted blood supply to the femoral head. Bone cells begin dying as a result. Pain and inflammation generally crop up, as do symptoms like impaired gait.
  2. Fragmentation: During this phase, which typically lasts a year or two, the body begins replacing dead bone with softer, more fragile bone. This process lays the foundation for healing, but the femoral head is extremely fragile at this point.
  3. Reossification: This is a time of bone strengthening and reshaping as the femoral head settles into a strong, secure position. The reossification process can take up to several years.
  4. Healed: At this point, the damaged bone has been completely regrown and replaced. The best outcome is to restore a round femoral head, but whether this happens depends in large part on the severity of the disease.

Shriners Hospitals for Children is staffed with an exceptional team of experienced pediatric orthopaedic specialists. We understand that every patient is a developing child with physical, emotional and psychological needs all their own. We're committed to delivering family-centered specialty care in an environment that makes children feel safe, respected and cared for.

What causes Legg-Calvé-Perthes disease?

Researchers are unsure of exactly what causes Legg-Calvé-Perthes disease. Interestingly, it's something that gradually heals itself when the blood supply returns. The body actually generates new bone and replaces the damaged one, sometimes numerous times, until the femoral head heals, though not in its original shape. The degree to which the hip joint is affected as the child grows is largely determined by the shape of the bone after healing occurs.

Shriners Hospitals for Children specializes in a variety of medical interventions to support and accelerate the natural bone regrowth process so that children with Legg-Calvé-Perthes disease are more comfortable and less disrupted by the condition.

Types of hip disorders

Legg-Calvé-Perthes disease is one of many pediatric hip disorders that Shriners Hospitals for Children helps families manage. We're deeply rooted in clinical research, using the latest orthopaedic breakthroughs to diagnose and treat a wide variety of hip conditions. We also have in-depth knowledge of and experience with the following disorders:

  • Developmental dysplasia of the hip (DDH): DDH represents a large spectrum of situations where the hip is not functioning as intended. This ball-and-socket joint depends on the femoral head fitting neatly into the socket where it can move easily, but sometimes the femoral head isn't sufficiently covered by the socket; other times, the hip is fully dislocated. Because it can range so much in severity, each case of DDH requires its own customized treatment plan.
  • Slipped capital femoral epiphysis (SCFE): This condition also affects the ball-shaped femoral head. It's a situation where, to some extent, the ball itself slips off the top of the thighbone. This triggers pain that can come on gradually or all at once. The cause of SCFE isn't clear, but it tends to occur during accelerated growth periods like puberty. Many children who experience it in one hip will also experience it in the other at some point, though this isn't always the case. The majority of children with SCFE who are treated at Shriners Hospitals for Children go on to have active, mobile lives, thanks to early intervention.
  • Femoroacetabular impingement (FAI): This is another hip disorder that typically arises during adolescence, often times in active children. FAI causes a minor misalignment of the hip socket and femoral head, resulting in groin pain. If left untreated, it can damage the joint's protective cartilage and soft tissue.

Treatment and management approaches

Hip disorders often impact mobility, which can be particularly challenging for a growing child. Shriners Hospitals for Children’s treatment approach is interidisciplinary and brings together specialists of all types to provide truly comprehensive care.

Condition-specific treatment options that may be appropriate:

  • Legg-Calvé-Perthes disease:
    • Non-surgical: The main objective of treatment is to maintain the roundness of the femoral head. Children under 6 years old tend to respond best to non-surgical interventions, which may include anti-inflammatory medications, activity restrictions, bracing or casting, crutches or a wheelchair to reduce weight bearing, and physical therapy.
    • Surgical: Surgery of the femur or the socket may be necessary to improve the shape of the joint so that the femoral head remains in place, and to prevent future arthritis.
  • Developmental dysplasia of the hip (DDH)
    • Nonsurgical: These methods are most common when a baby is less than 6 months of age. They typically consist of bracing a baby in such a way so that the hips are kept in a better position for hip joint development. The goal is to influence the natural growth processes so a more stable hip joint is developed. Positioning encourages normal hip joint development over time.
    • Surgical: If the hip stays in the joint and a complication known as avascular necrosis (AVN) does not happen, then the bones will look completely normal a couple of years after surgery. After most surgical procedures a spica (body) cast is used to keep the hip aligned in the new, corrected position while the tissues around the hip joint heal and reform into a proper hip joint.
  • Slipped capital femoral epiphysis (SCFE): A brief surgery is often performed to prevent further slipping by placing a pin in the femoral head. The majority of children treated for SCFE receive corrections that enable them to walk, play, grow and live active lives. Treating the child's SCFE as soon as symptoms develop greatly increases the likelihood of a successful outcome. However, since a significant percentage of children with SCFE in one hip will eventually develop the condition in the other hip, patients should continue to be followed by their orthopaedist until they are fully grown.
  • Femoroacetabular impingement: Treatment consists of activity modification, physical therapy and, if the hip cartilage is still intact, possible surgery to reshape the head of the femur or the socket


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