Perthes disease, Legg-Calve-Perthes disease

A child who has a hip problem may feel pain in the hip, groin, thigh, or knee. A child in pain may limp or be unable to stand, walk, or move the affected leg.

Legg-Calvé-Perthes disease is a childhood condition that affects the hip, is a temporary hip condition in which the femoral head loses its blood supply (avascular necrosis). Perthes disease usually involves just one hip, but both hips can be affected. It is rare for a child to have whole femur-head involvement.

The four stage of Perthes disease:

  • femoral head becomes more dense with possible fracture of supporting bone
  • fregmentation and reabsorption of bone
  • reossification
  • healing (new bone reshapes)


  • the first symptom is often limping, which is usually painless.
  • sometimes there may be mild pain (hip, groin, knee) that comes and goes.
  • later on, stiffness of the hip
  • limited range of motion
  • wasting of muscles in the upper thigh
  • when Perthes’ disease has been present for a long time, the affected leg may be shorter and thinner

The prognosis depends on the child’s age and the severity of the disease. In general, the younger the child is when the disease starts, the better the outcome. In the early stages an X-ray may appear normal and so other investigations such as MRI or bone scans may be performed.

The goal of treatment is:

  • to reduce hip pain and stiffness,
  • prevent deformity of the head of femur,
  • maintain the full range of motion hip mobility
  • to avoid severe degenerative joint disease


  • several months of bed rest
  • physical therapy to maintain the hip mobility and increasing strength (hip abductors, hip flexors, hip extensors, hip internal and external rotators, gluteus medius)
  • nighttime traction
  • surgery in extremely severe cases.