Materiały źródłowe

• #1 Legg-Calve-Perthes disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/symptoms-causes/syc-20374343

  Legg-Calve-Perthes (LEG-kahl-VAY-PER-tuz) disease is a childhood condition that occurs when blood supply to the ball part (femoral head) of the hip joint is temporarily interrupted and the bone begins to die. […] This weakened bone gradually breaks apart and can lose its round shape. The body eventually restores blood supply to the ball, and the ball heals. But if the ball is no longer round after it heals, it can cause pain and stiffness. The complete process of bone death, fracture and renewal can take several years. […] Symptoms of Perthes disease include: Limping. Pain or stiffness in the hip, groin, thigh or knee. Limited range of motion of the hip joint. Pain that worsens with activity and improves with rest. […] Perthes disease usually involves just one hip. Both hips can be affected, but they usually are affected at different times. […] Make an appointment with your healthcare professional if your child begins limping or complains of hip, groin or knee pain. If your child has a fever or can’t bear weight on the leg, seek emergency medical care.

• #2 Legg-Calve-Perthes Disease | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/legg-calve-perthes-disease

  Signs and symptoms of Perthes disease can include: […] Walking with a limp (can be a painless limp) […] Limited range of motion and stiffness in the hip, groin, thigh, or knee […] Pain in the hip, groin, thigh, or knee that gets worse during activity. […] The blood supply to the femoral head is disrupted, causing the hip joint to become inflamed, stiff, and painful. Areas of the bone turn into dead tissue (avascular necrosis). In X-rays, the femoral head appears less round. This phase can last from several months up to one year. […] The body cleans up the dead bone cells and replaces them with new, healthy bone cells. The femoral head begins to remodel into a round shape again, but the joint is still inflamed and painful. This phase can last up to two years. […] Healthy blood flow returns to the head of the femur and new bone grows, making the gap in the socket smaller.

• #3 Legg-Calve-Perthes (Perthes Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/legg-calve-perthes-disease

  Legg-Calve-Perthes disease is a rare condition that affects the hips of children aged 2 to 12. It starts when the head of the femur bone (the ball in the socket of the hip joint) temporarily loses its blood supply. When blood stops flowing to the bone, the tissue starts to die. After a while, the blood flow returns, and the bone slowly repairs itself. But it may not have its original shape and size. […] Signs and symptoms of Perthes develop over time and often with no clear beginning. You or your child might start to wonder whats up when symptoms appear and dont seem to ever get better. […] Early symptoms might include: A limp. Your child may favor one leg while walking to keep weight off the affected side. A limp often appears before your child notices any pain. They may not know why theyre limping. Hip pain. If your kid has pain, its most likely to occur early in the disease process, when the bone has lost its blood supply and its starting to degenerate. Pain worsens with activity. Referred pain. Some kids may feel pain in their knees, thighs, pelvises or abdomens instead. Leg cramps. Kids may experience muscle spasms in the leg muscles connected to their hip joints.

• #4 Perthes’ disease | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/perthes-disease

  Perthes’ disease is an uncommon condition that affects children between the ages of 3 and 11 years. […] This can cause pain, limping and limited movement of the hip joint. […] The symptoms of Perthes’ disease include: an occasional limp in the earlier stages, stiffness and reduced range of movement in the hip joint, pain in the knee, thigh or groin when putting weight on the affected leg or moving the hip joint, thinner thigh muscles on the affected leg, shortening of the affected leg, leading to uneven leg length, worsening pain and limping as time goes by. […] Most children with Perthes’ disease eventually recover, but it can take anywhere from 2 to 5 years for the femoral head to regrow and return to normal, or close to normal. […] In most cases, the blood supply to the hip joint returns and the femoral head regenerates by itself. This can take anywhere between 2 and 5 years.

• #5 Perthes Disease (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/perthes-disease.html

  Legg-Calv-Perthes (leg kal-VAY PER-teez) disease is a problem that changes the shape of the top of the thighbone (femur). The bone doesnt fit into the hip joint normally, causing pain and limping. […] Perthes disease can cause: […] Limping: Often the first sign of Perthes disease is a limp. Parents might notice a change in the way their child walks or runs during sports. One hip may seem stiff or have less movement. […] Pain: Most kids have some pain in the hip, groin, thigh, or knee. […] These problems may come and go, and usually are worse with activity and get better with rest. […] The changes happen slowly. It usually takes about 2-3 years from the time symptoms start until the bone is finished rebuilding.

• #6 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis. […] As the condition progresses, the weakened bone of the head of the femur (the ball of the ball-and-socket joint of the hip) gradually begins to collapse. Over time, the blood supply to the head of the femur returns and the bone begins to grow back. […] One of the earliest signs of Perthes is a change in the way your child walks and runs. This is often most apparent during sports activities. Your child may limp, have limited motion, or develop a peculiar running style, all due to irritability within the hip joint. Other common symptoms include: Pain in the hip or groin, or in other parts of the leg, such as the thigh or knee (this is known as referred pain)

• #7 Legg-Calvé-Perthes Disease in Children | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/l/legg-calve-perthes-disease.html

  Legg-Calv-Perthes disease (or Perthes disease) is a rare hip condition that affects children. […] Over a number of years, the ball-shaped top of a childs thighbone (femoral head) breaks down and re-forms. […] The hip joint becomes inflamed, stiff, and painful. […] Parts of the bone turn into dead tissue. […] The ball of the thighbone becomes less round. […] Children with Legg-Calv-Perthes disease have: Pain in their hip that gets worse with activity, Pain in the thigh or knee area, A limp, Muscle loss in the upper leg and hip. […] These symptoms may seem like other health problems of the hip. […] Children with this disease feel pain and stiffness in their hip joint. […] Treatment goals include controlling pain, maintaining hip motion, and keeping the hip deformity from getting worse.

• #8 Legg Calve Perthes Disease (LCP)

  https://www.nationwidechildrens.org/conditions/legg-calve-perthes-disease-lcp

  Pain and limping are the most common signs of the disease. This is often relieved with rest and decreased activities. More severe or later signs of LCP may even include decreased range of motion to the affected hip or unequal leg lengths. […] The femoral head continues to die and small bony pieces (breaks) occur. The femoral head is not smooth or round at this stage. This is usually when symptoms are present and most noticeable. This stage can last from 6 months to 2 years.

• #9

  https://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease

  Legg-Calve-Perthes Disease is an idiopathic avascular necrosis of the proximal femoral epiphysis in children. […] Symptoms include insidious onset, which may cause painless limp, and intermittent hip, knee, groin or thigh pain. […] Physical exam findings may include hip stiffness with loss of internal rotation and abduction, gait disturbance such as antalgic limp and Trendelenburg gait, and limb length discrepancy as a late finding. […] Hip related symptoms are most prevalent during the fragmentation stage, which can last from 6 months to 2 years. […] Early findings on radiographs include medial joint space widening from less ossification of the head, irregularity of femoral head ossification, and the crescent sign, which represents a subchondral fracture. […] The natural history of the disease suggests a variable course to final healing from the initial ischemic event, which can take 2-5 years to resolve.

• #10 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Pain that worsens with activity and is relieved with rest […] Painful muscle spasms that may be caused by irritation around the hip. […] Depending on your child’s activity level, symptoms may come and go over a period of weeks or even months before a visit to the doctor is considered. […] In the first stage of Perthes disease, the bone in the head of the femur slowly dies. […] In this stage of the disease, the blood supply to the femoral head is disrupted and bone cells die. The area becomes intensely inflamed and irritated, and your child may begin to show signs of the disease, such as a limp or different way of walking. This initial stage may last for several months. […] Over a period of 1 to 2 years, the body removes the dead bone beneath the articular cartilage and quickly replaces it with an initial, softer bone. It is during this phase that the bone is in a weaker state and the head of the femur is more likely to collapse into a flatter position. […] The reossification stage is often the longest stage of the disease and can last a few years.

• #11 Symptoms, Causes and Treatment of Perthes Disease | HSS

  https://www.hss.edu/conditions_legg-calve-perthes-disease-overview.asp

  Legg-Calve-Perthes disease (also called Perthes disease) is an uncommon pediatric hip disorder. It may cause a painless (or occasionally painful), intermittent limping and limited hip motion in growing children. […] A child with Legg-Calve-Perthes disease will limp and sometimes complain of thigh or knee pain. Persistent limping as well as limited motion of the affected hip are what generally lead to a doctors evaluation and eventual referral to a pediatric orthopedic surgeon. […] If a limp is steady or intermittent and persists or recurs, it is appropriate to consult a pediatric orthopedic surgeon.

• #12 Legg-Calve-Perthes (Perthes Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/legg-calve-perthes-disease

  Later signs and symptoms of LCPD may include: Trendelenburg gait. This is an abnormal walking pattern thats characteristic of hip problems. Weak hip muscles cause the pelvis to tilt downward on the affected side as your child walks. Limited range of motion. Your child may have difficulty rotating their hip. They may not be able to open their thighs outward or turn their knees inward as far as they used to. Muscle atrophy. You may notice loss of muscle mass in your childs thighs and buttocks. Leg length discrepancy. One leg may appear shorter than the other. […] While Legg-Calve-Perthes is active, the head of your childs femur bone in their hip socket will go through a process of degeneration (breakdown) and then regeneration (rebuilding). The breakdown phase may take up to a year, and the rebuilding and remodeling phase may last two to five years.

• #13 Legg-Calvé-Perthes Disease – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/bone-disorders-in-children/legg-calv%C3%A9-perthes-disease

  Legg-Calv-Perthes disease can cause severe hip damage before significant symptoms occur. The severe damage may, however, lead to permanent arthritis of the hip. […] The first symptom of Legg-Calv-Perthes disease often is pain in the hip joint and trouble walking. Pain begins gradually and progresses slowly. The pain tends to worsen when moving the hip or walking. Some children complain of pain only in the knee. A limp can develop, sometimes before the child has much pain. Eventually, joint movement becomes limited, and the thigh muscles may become wasted (atrophied) from lack of use. […] Young children and children who have less damage when they are diagnosed have the best outcome. […] Even without treatment, Legg-Calv-Perthes disease usually gets better, but it takes longer, usually 2 to 3 years, and there is an increased risk of hip arthritis developing later in life.

• #14 Legg-Calve-Perthes Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513230/

  Legg-Calve-Perthes disease (LCPD) is idiopathic osteonecrosis or idiopathic avascular necrosis of the capital femoral epiphysis of the femoral head. […] Legg-Calve-Perthes disease usually occurs between the ages of 3 to 12 years old, with the highest rate of occurrence at 5 to 7 years. […] Limp of acute or insidious onset, often painless (1 to 3 months) […] If pain is present, it can be localized to the hip or referred to the knee, thigh, or abdomen […] With progression, pain typically worsens with activity. […] Decreased internal rotation and abduction of the hip […] Pain on rotation referred to the anteromedial thigh and/or knee […] Antalgic gait (acute): Short-stance phase secondary to pain in the weight-bearing leg […] Trendelenburg gait (chronic): Downward pelvic tilt away from the affected hip during the swing phase.

• #15 Perthes’ Disease: Symptoms, Causes, and Treatment

  https://patient.info/bones-joints-muscles/hip-problems/perthes-disease

  As the hip becomes more damaged, the affected hip becomes stiff. A limited range of motion of the hip develops. […] Because the affected leg can’t be used normally, the leg’s muscles will become weaker. This causes the thigh muscles on the affected side to become wasted and so the leg looks thinner when you compare it with the other leg. This may not be obvious when both hips are affected. […] However, this can take two or more years after the condition first starts. Even after this time, there may be some stiffness remaining in the hip and there is an increased risk of osteoarthritis in later life. […] The younger the child is when Perthes’ disease develops, the better the chance of a good outcome. Children who develop Perthes’ disease after about the age of 8-9 years have the highest risk of permanent hip joint problems, such as stiffness and arthritis. […] The more severe the condition, the greater the risk of permanent problems with the hip joint.

• #16 Legg-Calvé-Perthes Disease – Seattle Children’s

  https://www.seattlechildrens.org/conditions/legg-calve-perthes-disease/

  Children with Perthes disease often have a slight limp. In the early stages, they typically have a limp without any hip pain or soreness. Other symptoms include: […] Stiffness in the hip […] Pain in the knee, thigh or groin […] Limited range of motion in the hip […] Upper thigh muscles get smaller […] Legs appear to be different lengths.

• #17 Legg–Calvé–Perthes disease – Wikipedia

  https://en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_disease

  The condition is most commonly found in children between the ages of 4 and 10. Common symptoms include pain in the hip, knee, or ankle (since hip pathology can cause pain to be felt in a normal knee or ankle), or in the groin; this pain is exacerbated by hip or leg movement, especially internal hip rotation (with the knee flexed 90, twisting the lower leg away from the center of the body). The range of motion is reduced, particularly in abduction and internal rotation, and the patient presents with a limp. Pain is usually mild. Atrophy of thigh muscles may occur from disuse and an inequality of leg length. In some cases, some activity can cause severe irritation or inflammation of the damaged area, including standing, walking, running, kneeling, or stooping repeatedly for an extended period. In cases exhibiting severe femoral osteonecrosis, pain is usually a chronic, throbbing sensation exacerbated by activity

• #18 ALL YOU NEED TO KNOW ABOUT LEGG–CALVÉ–PERTHES DISEASE: SYMPTOMS, CAUSES, AND TREATMENT | Mya Care

  https://myacare.com/blog/all-you-need-to-know-about-legg-calve-perthes-disease-symptoms-causes-and-treatment

  Muscle weakness or wasting. The child may have reduced muscle strength or size in the thigh or buttock of the affected side due to disuse or inflammation of the hip joint. […] Leg length discrepancy. The affected leg may become shorter or longer than the other leg due to bone loss, depending on the degree of bone loss or growth disturbance. […] The symptoms of LCPD may vary depending on the stage and severity of the disease, as well as the age and activity level of the child. […] The symptoms of LCPD may come and go over several months or years, depending on the healing process of the bone. […] The first sign is often pain, as well as a misaligned walking gait. […] It may be delayed or missed in the initial phase when the femoral head loses blood circulation, causing the hip joint to become painful, rigid, and irritated and the bone becomes mostly composed of dead tissue.

• #19 Pediatric Legg-Calve-Perthes Disease | Children’s Healthcare of Atlanta

  https://www.choa.org/medical-services/orthopedics/hip-program/legg-calve-perthes-disease

  Phase 2: 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 one to three years. […] Phase 3: The femoral head continues to model itself back into a round shape with new bone. This phase lasts one to three years. […] Phase 4: Normal bone cells replace new bone cells. This last phase can last a few years to complete the healing process. […] It is important to understand that every affected child goes through each phase, from beginning to end. This whole process can extend over many months to years.

• #20 Getting to Know the Four Stages of Perthes | International Perthes Study Group

  https://perthesdisease.org/2016/09/08/getting-to-know-the-four-stages-of-perthes/

  Perthes disease has four stages. The first stage, also known as the onset or necrosis stage, begins when the child first begins to limp and complain of pain. From the initial stage, the disease progresses as the body attempts to remove the damaged bone in order to begin new bone growth. […] A limp and pain begins. Damage occurs when blood flow to the center of the hip stops working. Pain is usually mild and x-rays may appear normal. A crescent sign (crescent shaped crack) and a break can be seen under the joint surface. Duration: a few weeks to months. […] Stage where the body attempts to repair itself, but also the stage when most of the femoral head fragmentation and collapse occurs. Brittle bone that lost its blood supply must be removed so that the body can grow new, healthy bone. On x-rays, the ball of the hip appears broken up thus the term fragmentations. It sometimes looks like Swiss cheese with patchy holes, which are the areas where the dead bone is being removed by repairing cells. The biggest concern at this stage is that the bone is at the greatest risk of collapsing which can permanently deform the ball. The outer part of the ball may also come outside of the joint. Containment treatment is used in this stage if a part of the ball comes out of the joint. The ball is contained in the hip socket by casting, bracing, or surgery so that the socket can act as a mold to keep the ball round while the dead bone is adsorbed and new bone grows. The main goal is to keep the ball in the socket during the fragmentation stage. Containment is more effective if the treatment begins before the ball collapses (the ball does not collapse in every case of Perthes). Duration: 6 months to a year.

• #21 Legg-Calve-Perthes Disease | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/legg-calve-perthes-disease

  Signs and symptoms of Perthes disease can include: […] Walking with a limp (can be a painless limp) […] Limited range of motion and stiffness in the hip, groin, thigh, or knee […] Pain in the hip, groin, thigh, or knee that gets worse during activity. […] The blood supply to the femoral head is disrupted, causing the hip joint to become inflamed, stiff, and painful. Areas of the bone turn into dead tissue (avascular necrosis). In X-rays, the femoral head appears less round. This phase can last from several months up to one year. […] The body cleans up the dead bone cells and replaces them with new, healthy bone cells. The femoral head begins to remodel into a round shape again, but the joint is still inflamed and painful. This phase can last up to two years. […] Healthy blood flow returns to the head of the femur and new bone grows, making the gap in the socket smaller.

• #22 Pediatric Legg-Calve-Perthes Disease | Children’s Healthcare of Atlanta

  https://www.choa.org/medical-services/orthopedics/hip-program/legg-calve-perthes-disease

  Legg-Calve-Perthes disease causes the hip joint to become painful and stiff. It can also leave the femoral head deformed and lead to disability. […] The most common signs of Perthes disease include: Walking with a slow limp that occurs at irregular intervals. Having limited range of motion in the hip. Having pain in the hip, thigh or knee, though pain is not usually a major factor. Pain often seems more activity-related. […] During the initial examination, the doctor may find a child that limps has loss of motion around the hip and, in cases of longer duration, evidence of muscle wasting. […] Phase 1: Blood stops reaching the femoral head, and the hip joint becomes inflamed, stiff and painful. Portions of the bone turn into dead tissue. The ball of the thighbone becomes less round. This phase can last from several months up to one year.

• #23 Perthes Kids Foundation

  http://www.pertheskids.org/stages

  On x-rays, the femoral head looks whiter and smaller than the unaffected side due to the disruption of blood flow that causes bone death. Early flattening of the top of the femoral head or fracture line (called subchondral fracture or crescent sign) can be seen. […] In this stage, the femoral head looks irregular and broken up (fragmented) with a more flattened appearance. These x-ray irregularities are due to the dead bone being removed by the healing process creating areas without bone (seen as dark areas on x-rays). […] In this stage, new bone (seen as increased white appearance of the femoral head) starts to fill in the areas where the dead bone has been removed. […] In this stage, the appearance of the bone in the femoral head looks similar to the normal side. It is homogeneous and the irregular, fragmented appearance is no longer seen.

• #24 Legg Calve Perthes Disease – OrthoPaedia

  https://www.orthopaedia.com/legg-calve-perthes-disease/

  The fragmentation stage is characterized by revascularization and bone resorption producing collapse. Hip symptoms are most pronounced in this stage, which may present for a year or longer. […] In the reossification stage, new bone appears as the necrotic bone is resorbed. This is the longest stage and may persist for two years or more. […] In the final stage, the femoral head completes its remodeling. This stage is labeled the “healed” stage – a term that refers specifically to the completion of the bone’s response to the original insult. The word “healed” does not necessarily reflect the state of the hip joint overall. That is, although the osteonecrosis process may have ended and the fragmented areas have reconsolidated, symptoms may still persist and later degenerative changes may still appear if the shape of the femoral head has not been restored to normal.

• #25 Getting to Know the Four Stages of Perthes | International Perthes Study Group

  https://perthesdisease.org/2016/09/08/getting-to-know-the-four-stages-of-perthes/

  Occurs when all the dead bone, which appears white on x-ray has dissolved. The shape of the ball at this stage may still improve as the patient grows. This is one of the reasons why a younger child affected with Perthes do better than an older child, since a younger child has more growth left. Containment treatment at this stage is no longer an effective treatment plan. Bone begins to fill in the holes of the ball. This is the stage when the ball starts to become bigger than the normal size in some children with severe Perthes. This is called coxa magna (big head). Growth of the femoral neck may also be affected and shows up as short and broad neck below the enlarged ball. This stage usually becomes present by 18 months after the first onset of pain or limb occurs It could take 2 to 3 years for the entire ball to be filled with new bone. The child can return to full activity once the round, slightly enlarged shape of the ball is becoming visible on the x-ray.

• #26 What is Legg-Calvé-Perthes disease (LCPD)?

  https://www.medicalnewstoday.com/articles/legg-calve-perthes-disease

  During this stage, the body gradually reabsorbs dead bone cells and replaces them with new, healthier ones. The femoral head starts to reform into a rounder shape. This process may cause pain and limited mobility and can last up to 3 years. […] In this stage, new blood vessels begin to form, providing the necessary nutrients and oxygen to the fragmented bone. The femoral head continues to reform into a round shape with new bone. This phase may last for up to 3 years. […] The final stage involves the reshaping of the femoral head with regular bone cells to restore a more spherical appearance. This stage may take a few years to complete the healing process.

• #27 Getting to Know the Four Stages of Perthes | International Perthes Study Group

  https://perthesdisease.org/2016/09/08/getting-to-know-the-four-stages-of-perthes/

  Occurs when the ball has been replaced with bone. When the ball is round and the shape of the upper thighbone is normal, long-term outcome is very good and no arthritis is expected in most patients. If the ball is oval shape, arthritis could develop by age 50 to 60 in about 50% of the patients. The worst residual hips are flat or saddle shaped the chance of getting early arthritis is higher. This is one of the reasons why we treat a child with Perthes early in order to prevent the ball from becoming very flat.

• #28 Legg-Calve-Perthes Disease: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1248267-overview

  The prognosis for patients with LCPD can be good; it depends on the completeness of involvement of the epiphyseal center. The severity of involvement of the femoral head, its subsequent healing, and proper joint space preservation all help determine when and to what degree an athlete will be able to participate in sports. The functional result depends on the amount of deformity that develops when the structure is softened. Overall, the prognosis for recovery and sports participation after treatment is very good for most individuals. […] The short-term prognosis is related to femoral head deformity at the completion of the healing stage. Risk factors include the following: Clinical onset at an older age, Extensive femoral epiphyseal involvement, Femoral head containment, Reduced range of motion in the hip, Premature closure of the growth plate.

• #29 Legg–Calvé–Perthes disease overview | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-022-02275-z

  The duration of each stage is very variable, but, in general, the necrosis and fragmentation stage last about six months; the reossification stage, from 18 months to three years; and the final phase, until bone maturation. According to other authors, the fragmentation phase lasts approximately one year, and the reossification phase, from three to five years. […] The sequelae found in LCPD patients after the age of 40 are minimal, and the long-term prognosis tends to be good in 60% to 80% of the total cases. There are multiple prognostic factors in LCPD, such as age of onset and diagnosis, sex, range of motion of the hip, and classification. While, in general, patients between five to seven years old have a better prognosis than those of older ages, patients in adolescence have a poor prognosis. In the case of women, it is reported that they tend to have a worse prognosis; however, Guille et al, report that the prognosis can be similar between men and women. Finally, bilateral cases also present a poor prognosis. The severity of the damage, the classification of the patient, the size of the damaged area and the treatment used must be considered.

• #30 Legg-Calve-Perthes Disease: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1248267-overview

  The long-term prognosis is related to the potential for osteoarthritis of the hip as an adult. It is worse for patients with metaphyseal defects, those in whom the disease develops late in childhood (age 10 y), and those who have more complex involvement of the femoral head with residual deformity; degenerative arthritis occurs in nearly 100% of these patients. This rate is in comparison to patients who are younger than 5 years when the problem develops; the incidence of degenerative arthritis is negligible in this younger population.

• #31 Legg–Calvé–Perthes disease – Wikipedia

  https://en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_disease

  Children younger than six have the best prognosis, since they have time for the dead bone to revascularize and remodel, with a good chance that the femoral head will recover and remain spherical after resolution of the disease. Children who have been diagnosed with Perthes’ disease after the age of ten are at a very high risk of developing osteoarthritis and coxa magna. When an LCP disease diagnosis occurs after age eight, a better outcome results with surgery rather than nonoperative treatments.

• #32 Legg Calve Perthes Disease

  https://www.massgeneral.org/orthopaedics/children/conditions-and-treatments/legg-calve-perthes-disease

  Legg Calv Perthes disease (LCPD) – also known as ischemic (avascular) necrosis of the hip – is a condition characterized by a temporary loss of blood supply to the femoral head (top of the femur). The typical course of LCPD is an initial ischemic necrosis of the femoral head (loss of blood supply), followed by collapse and subsequent remodeling (re-shaping to normal sphere shape) […] Common symptoms include a painless limp, mild or intermittent pain in the hip, knee, groin, or anterior thigh, a painful limp that is worsened by activity, mild restriction of motion (on abduction and internal rotation), and possible mild quadriceps/thigh weakness or atrophy. […] The long-term prognosis for Perthes disease is generally quite good, especially for children who develop the condition at a very young age (4-5 years). The younger the child, the more time there is to reshape the affected hip bone. If the femoral head maintains its spherical shape and is contained in the acetabulum, the prognosis for a normal hip is excellent. The two most critical factors that determine the outcome are the childs age at diagnosis and how much of the femoral head is affected. Older children (diagnosis at age 7-10 years) with greater involvement are generally more likely to have limited hip motion, difference in leg lengths, and arthritis in early adulthood. The goals of treatment are to keep the hip pain free, allow full participation in all sports and activities, and prevent or delay the development of early hip degenerative arthritis.

• #33 Perthes disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/perthes-disease?lang=us

  Prognosis is also influenced by the percentage of femoral head involvement and degree of primary deformity of the femoral head and the secondary osteoarthritic changes that ensue. Children older than 8 years or with over 50% of femoral head necrosis at time of diagnosis should be considered for operative management.

• #34 Perthes Disease | International Center for Limb Lengthening

  https://www.limblength.org/conditions/perthes-disease/

  The range of motion of the involved hip joint is the most important factor. This was noted from the very first time this disease was identified by Dr. Arthur Legg and Dr. Jacques Calv (1910). Motion is essential to maintain the roundness of the femoral head. During the process of Perthes disease, the inner bone that supports the round cartilaginous femoral head begins to fail as the dead bone is absorbed by the body. The loss of this inherent stability of the femoral head creates a situation where the femoral head softens and takes on the characteristics of a ball of molding clay or a water balloon. […] If the hip motion is lost and the soft femoral head is stuck in one position, then the edges of the hip acetabulum (hip cup) push down on the soft femoral head and change the shape of the hip ball. This femoral head deformation causes a mismatch in the shape of the hip ball and cup which leads permanent loss of motion, wear and tear on the joint, impingement pain, and eventual arthritis. Impingement pain occurs when the hip no longer moves freely (it gets stuck).

• #35 Legg-Calve-Perthes Disease | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/legg-calve-perthes-disease

  Normal bone cells replace the new bone cells, and the femoral head becomes more of a mushroom shape than a ball. This phase can last a few years as the bone heals. […] Diagnosing and treating your child’s Perthes disease early in its development greatly increases the likelihood of a successful outcome. The majority of children treated for Perthes disease have corrections that enable them to walk, play, grow, and live active lives. […] Even after successful treatment in childhood, some children develop hip problems later in life.

• #36 Legg-Calve-Perthes Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK513230/

  Typically, Legg-Calve-Perthes disease includes four phases: […] The new femoral head may be enlarged or flattened. It reshapes during growth. Those that respond to conservative treatment will usually show healing in 2 to 4 years. […] Fifty percent of patients develop pain and disability in their 40s and 50s and degenerative joint disease leading to hip replacement in their 60s and 70s. […] As Legg-Calve-Perthes disease progresses, various deformities of the femoral head can develop. The most common are coxa magna (widening of the femoral head) and coxa plana (flattening). […] A late complication of this childhood disease is hip arthritis.

• #37 Legg-Calve-Perthes Disease | PM&R KnowledgeNow

  https://now.aapmr.org/legg-calve-perthe-disease/

  Legg-Calv-Perthes disease (LCPD) is a syndrome of unilateral or bilateral idiopathic avascular necrosis of the proximal femoral head (FH) in children resulting from compromise of the blood supply to the developing capital femoral epiphysis. It is one of the most common causes of permanent femoral head deformity in children. The disease affects children between ages 3 and 12 with a peak incidence between ages 5 and 7. LCPD can be divided into four stages (with subgroups) based on the modified Waldenstrom radiographic classification, which has high inter-and intra-rater reliability. Determinates of the duration of each stage and total duration of the active phase is unknown, but older patients appear to have a longer duration than younger patients. Symptoms increase with activity and diminish with rest. More definite loss of hip internal rotation and abduction occurs in the fragmentation phase. Patients gradually improve, and after 2 years are usually back to normal activity with little complaints. Permanent femoral head deformity in LCPD predisposes children to early onset and/or more severe course of osteoarthritis of the hip, as well as leg length discrepancy. By the 6th decade, 50% of untreated patients will develop disabling osteoarthritis requiring a hip replacement. The child often participates in high impact sports, has smoke exposure, or deprivation. Typically, the parents report that the child complains of occasional groin, thigh or knee pain, and limps. The principal of treatment is containment of the femoral head within the spherical acetabulum to allow spherical re-ossification.

• #38 Legg Calve Perthes Disease – OrthoPaedia

  https://www.orthopaedia.com/legg-calve-perthes-disease/

  Overall, the long-term prognosis for children with Perthes is good; most children are able to return to daily activities without symptoms or limitations. The most important predictors of long-term prognosis are age at the time of diagnosis and the eventual shape and congruity of the femoral head within the acetabulum. Younger patients typically do better, and more spherically-shaped heads and greater congruity of the head within the hip joint portend better outcomes.

• #39 Legg–Calvé–Perthes disease – Wikipedia

  https://en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_disease

  The first signs are complaints of soreness from the child, which are often dismissed as growing pains, and limping or other joint guarding, particularly when tired. The pain is usually in the hip, but can also be felt in the knee (referred pain). In some cases, pain is felt in the unaffected hip and leg, due to the children favoring their injured side and placing the majority of their weight on their „good” leg. It is predominantly a disease of boys (4:1 ratio). Perthes is generally diagnosed between 5 and 12 years of age, although it has been diagnosed as early as 18 months. Typically, the disease is only seen in one hip, but bilateral Perthes is seen in about 10% of children diagnosed. […] Symptoms like femoral head disfigurement, flattening, and collapse occur typically between ages four and ten, mostly male children of Caucasian descent. Children affected by LCP disease often display uneven gait and limited range of motion, and they experience mild to severe pain in the groin area.

• #40 Diagnosing Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/diagnosis

  Perthes disease, which usually affects just one hip, is five times more common in boys than in girls and often occurs in children four to eight years old. […] Most symptoms occur gradually, after blood flow to the hip returns and the hip joint begins to repair itself. The most common symptom is a limp caused by inflammation, stiffness, and pain. Perthes disease can affect range of motion in the hip, and it can also make the affected leg slightly shorter than the other. Pain in the hip can cause muscle spasms in the pelvis and leg. […] Perthes disease can lead to arthritis if the abnormally shaped femoral head causes chronic inflammation. Early identification and treatment are therefore important. Efforts to ensure that the hip joint heals properly while the child is still growing may reduce the risk of arthritis and other hip problems later in life.

• #41 Legg-Calvé-Perthes disease: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/legg-calve-perthes-disease/

  Legg-Calvés disease is a bone disorder that affects the hips. People with this condition often have pain in the hip joint and restricted movement. Usually, the condition involves only the right hip or only the left hip, but 10 to 20 percent of affected individuals have signs and symptoms in both hips. Legg-Calvés disease begins in childhood, typically between 3 and 12 years of age. Boys are three to five times more likely than girls to be affected by Legg-Calvés disease. […] Legg-Calvés disease interrupts the blood supply to the upper end of the thigh bone (femoral head). The disruption in blood flow causes bone cells to die. As a result, the femoral head can become misshapen and may no longer move easily within the hip socket. This can cause hip or knee pain and limit the range of motion in the leg. The bone eventually begins to heal through a normal process called bone remodeling, by which old bone is removed and replaced by new bone. This cycle of breakdown and healing can recur multiple times. If the damage to the femoral head does not heal properly, one leg may become shorter than the other. […] Without proper treatment, some people with Legg-Calvés disease will develop a painful joint disorder called osteoarthritis, which may require a hip replacement later in life.

• #42 PERTHES DISEASE (LEGG-CALVE-PERTHES DISEASE) – Description

  https://davidslattery.com/hip-conditions/perthes-disease/description/

  Perthes disease typically occurs in children who are between 4 and 10 years old. It is five times more common in boys than in girls, however, it is more likely to cause extensive damage to the bone in girls. In 10% to 15% of all cases, both hips are affected. The cause of Perthes disease is not known. […] One of the earliest signs of Perthes is a change in the way your child walks and runs. This is often most apparent during sports activities. Your child may limp especially after running or sports activities. Other common symptoms include: Pain in the hip or groin, or in other parts of the leg, such as the thigh or knee (called referred pain.). Pain that worsens with activity and is relieved with rest. Painful muscle spasms that may be caused by irritation around the hip. […] Depending upon your child’s activity level, symptoms may come and go over a period of weeks or even months before a doctor visit is considered. […] In the first stage of Perthes disease, the bone in the head of the femur slowly dies. […] In this X-ray, Perthes disease has progressed to a collapse of the femoral head (arrow). The other side is normal.

• #43 Legg-Calve-Perthes Disease: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1248267-overview

  Legg-Calv-Perthes disease (LCPD) is avascular necrosis (AVN) of the proximal femoral head resulting from compromise of the tenuous blood supply to this area. LCPD usually occurs in children aged 4-10 years. The disease has an insidious onset and may occur after an injury to the hip. In the vast majority of instances, the disorder is unilateral. Both hips are involved in fewer than 10% of cases, and the joints are involved successively, not simultaneously. […] The earliest sign of is an intermittent limp (abductor lurch), especially after exertion, with mild or intermittent pain in the anterior part of the thigh. Hip pain may develop and is a result of necrosis of the involved bone. Pain may be present with passive range of motion (ROM) and limited hip movement, especially internal rotation and abduction. Children with LCPD can have a Trendelenburg gait resulting from pain in the gluteus medius.

• #44 Perthes’ Disease: Symptoms, Causes, and Treatment

  https://patient.info/bones-joints-muscles/hip-problems/perthes-disease

  Perthes’ disease usually only affects one hip. But both hips are affected in about 1 in 7 children who have Perthes’ disease. […] The symptoms usually develop gradually over a period of time. The first indication that a child may have Perthes’ disease is when they develop a limp. The affected hip is often but not always painful. The symptoms may include: […] The affected hip is often painful and pain is also felt in the groin. The pain is also often felt in the thigh and the knee. This is not because the knee is affected but because hip pain is often felt in the knee. This is called referred pain. […] The leg of the affected hip may become shortened compared with the unaffected side. […] Children with Perthes’ disease often develop a limp, which becomes gradually worse over a few weeks.

• #45

  https://www.shrinerschildrens.org/en/pediatric-care/legg-calve-perthes

  Legg-Calv-Perthes disease, or Perthes disease, is a childhood bone disorder that typically only affects one hip, although roughly 10% 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 impacts mobility, causes pain, and can lead to early-onset osteoarthritis.

• #46 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Legg-Calve-Perthes-Disease.aspx

  The first sign of Legg-Calv-Perthes disease is usually limping. The child does not usually complain of pain, although some intermittent pain is occasionally reported. […] Symptoms may include: Limping, Hip stiffness, Limited movement and range of motion, Thigh, groin or knee pain, Shortening of one leg, leading to unequal leg length, Loss of thigh muscle. […] The condition is usually unilateral, which is what causes the unevenness of the gait and posture, and limping.

• #47 Legg–Calvé–Perthes disease overview | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-022-02275-z

  LeggCalvPerthes Disease (LCPD) is characterized by, unilateral or bilateral, necrosis of the femoral head (FH). Which affects the range of motion of the hip. In our experience, patients generally report pain in the affected joint, which intensifies during and after physical activity. On the other hand, lameness or trendelenburg gait is characterized by being the main sign for which they come for consultation. […] The main symptoms of LCPD are lameness and localized pain in the hip, radiating to the thigh and knee; nonetheless, some cases present painless limp. It is common to find limitation of abduction and internal rotation, as well as limitation in flexion of approximately 20 degrees. In some cases, there is shortening of the affected extremity. […] LCPD usually appears from the age of 3 to 12 years old, with the highest rate of occurrence at the age of 5 to 7 years old.

• #48 Legg-Calve-Perthes Disease | Illinois Bone & Joint Institute

  https://www.ibji.com/services/legg-calve-perthes-disease/

  Symptoms may come and go over a period of weeks or months depending on your child’s activity level. […] Change in the way your child walks and runs […] Limping without pain […] Limited motion […] Feeling stiffness and pain in your hip, thigh, groin, or knee […] Having legs of unequal length […] Wasting away of thigh muscles […] Pain that worsens with activity and is relieved with rest […] Muscle spasms caused by irritation around the hip.

• #49 Legg-Calve-Perthes Disease | Symptoms, Diagnosis, and Treatment

  https://www.cincinnatichildrens.org/health/l/legg-calve-perthes-disease

  Symptoms can include: […] Limping, which may get worse late in the day or after activities. This gets better with rest. […] Pain in the groin, front of the thigh, or knee that gets worse with physical activity. The pain often is worse late in the day. Some children may have pain at night. […] The child’s pain and limp become more obvious. […] The pain and limp usually start to improve. […] For about two years, the child will be restricted from many activities including running and jumping. Even after LCPD / AVN has resolved, it is best if your child avoids contact and collision activities. They should also avoid running and cutting sports.

• #50 Legg-Calve-Perthes disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348

  During the physical exam, your healthcare professional might move your child’s legs into various positions to check range of motion and see whether any of the positions cause pain. […] Initial X-rays may not show changes in the hip. It can take 1 to 2 months after symptoms begin for the changes related to Perthes disease to become clear on X-rays. Your healthcare professional will likely recommend several X-rays over time to track the progression of the disease. […] In Perthes disease, the complete healing process can take several years. The types of treatment recommended depend on the: Age when symptoms began. Stage of the disease. Amount of hip damage. […] As Perthes disease gets worse, the ball part of the joint, called the femoral head, weakens and breaks apart. […] Some children, especially very young ones, might need only conservative treatments or observation.

• #51 Legg-Calve-Perthes disease – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348

  Children with Perthes disease should not run, jump or take part in other high-impact activities that might speed up hip damage. […] Your healthcare team might ask some of the following questions: What are your child’s symptoms? Have they gotten worse over time? Do the symptoms seem to come and go? […] Does activity make your child’s symptoms worse? Does resting ease your child’s discomfort?

• #52 Legg-Calvé-Perthes disease in children – Children’s Health Orthopedics

  https://www.childrens.com/specialties-services/conditions/legg-calve-perthes-disease

  Legg-Calv-Perthes disease happens when blood is not flowing properly to the head of the thighbone (femur), causing the bone to decay. Children with Legg-Calve-Perthes disease may have hip pain, joint stiffness and muscle weakness. […] Signs and symptoms of Legg-Calv-Perthes disease include: Stiffness, Limited range of motion, Pain in the hip, groin, thigh or knee especially with activity, Limping. […] If your child is experiencing hip pain, limited range of motion or weakness in the hip joint, our physicians will conduct a thorough diagnosis to determine if Legg-Calv-Perthes disease is the problem. […] Legg-Calv-Perthes disease can be successfully treated, with the help of our expert physicians. Our treatment ensures the bone heals properly, preserving the round shape of its head. This approach helps restore the joints normal function and avoids other hip problems.

• #53 Perthes Disease (Legg-Calvé-Perthes Disease): Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/orthopedics/columbia-orthopedics/perthes-disease

  The pain a child experiences may not be consistent and can occur on and off over several months. Contact a healthcare provider if your child exhibits symptoms, as X-rays may be necessary to detect and diagnose Perthes disease. […] Pediatric surgeons at NewYork-Presbyterian Columbia Orthopedics can guide and provide care in diagnosing and treating Legg-Calv-Perthes disease. Our experts can confirm a diagnosis using an X-ray and will perform regular tests to track progression and recovery. Early diagnosis will allow more time for the femoral head to heal and recover.

• #54 Legg-Calvé-Perthes disease in children – Children’s Health Orthopedics

  https://www.childrens.com/specialties-services/conditions/legg-calve-perthes-disease

  Sometimes symptoms worsen and surgery may be required. An expert pediatric surgeon realigns the joint, to hold the thighbone head in the hip socket while the bone and joint heal. […] When Legg-Calv-Perthes disease is detected and treated early, physicians can help avoid further damage and decay to the head of the thighbone. If Legg-Calv-Perthes disease is left untreated, children may develop limb-length discrepancies, arthritis and other hip problems as adults.

• #55 Legg-Calvé-Perthes Disease: Symptoms & Treatment

  https://www.gillettechildrens.org/conditions-care/perthes-disease-symptoms-and-treatment

  If your child has Legg-Calv-Perthes disease (often shortened to simply Perthes), symptoms may include: […] Pain in any of the following areas: groin, hip, inner thigh, or knee. […] Limping, perhaps without a known cause or injury. […] Limited hip range of motion. […] Once your child’s hip has healed completely, the disease is unlikely to return, but the hip may retain an abnormal shape. Gillette orthopedic surgeons continually see and monitor progress in children with Perthes until they stop growing and reach skeletal maturity. Once the hip has healed, other surgical procedures may be indicated if the hip continues to be problematic due to non-spherical shape or due to limitations in hip function.

• #56 Traumatología infantil | Enfermedad de Legg-Calvé Perthes

  https://elgeaditraumatologia.com/en/enfermedad-legg-calve-perthes-tratamiento/

  The younger the child is at the time of diagnosis, the better the prognosis for recovery; It is important to go as soon as possible to a orthopedic doctor if the child limps or complains of pain in the hip, thigh or knee. […] From the time the disease is diagnosed to recovery it can take more than 18 months, and often more than two years. Correct repair of the joint is important to minimize the risk of future complications and sequelae. […] Children who have had Perthes disease are at greater risk of developing hip conditions as adults, such as arthritis. To reduce this risk, early diagnosis and adequate treatment in the hands of professional traumatologists to restore the rounded shape of the head of the femur.

• #57 Legg-Calvé-Perthes Disease – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/bone-disorders-in-children/legg-calv%C3%A9-perthes-disease

  Legg-Calv-Perthes disease has a maximum incidence at age 5 to 10 years, is more common among boys, and is usually unilateral. […] Characteristic symptoms of Legg-Calv-Perthes disease are pain in the hip joint and gait disturbance (eg, limping); some children complain of pain in the knee. Onset is gradual, and progression is slow. Joint movements are limited, and thigh muscles may become wasted. […] Without treatment, the course is usually prolonged but self-limited (usually 2 to 3 years). When the disease eventually becomes quiescent, residual distortion of the femoral head and acetabulum predisposes to secondary degenerative osteoarthritis. […] With treatment, sequelae are less severe. Young children and children with less femoral head destruction when diagnosed have the best outcome.

Zobacz więcej