The treatment of Legg-Calvé-Perthes disease is directed toward the specific symptoms presented by each individual. Treatment varies with the severity of symptoms and may require the coordinated efforts of a team of specialists. Pediatricians usually refer patients to specialists who diagnose and treat disorders of the skeleton, joints, muscles, and related tissues (orthopedists); orthopedic surgeons, especially those that specialized in pediatrics; physical therapists; and other health care professionals may need to systematically and comprehensively plan an affected child’s treatment.
Degenerative bone changes associated with LCPD usually heal on their own without intervention (spontaneously). Affected children should be closely monitored so the progression of the disease may be evaluated to ensure the bone reforms properly. Physical therapy may be recommended to maintain a good range of motion of the joint. Radiologic studies (e.g., MRI, arthrography, and bone scan) may be used to assist in monitoring the progression of the disease.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be used for mild to moderate pain.
In other cases, decreased physical activity, bedrest (if pain is present and prolonged) with or without traction, and/or stretching exercises (if stiffness occurs), particularly exercises in which the legs are rotated away from the body (abduction exercises), may be recommended to decrease pain in the hip and maintain proper mobility of the joint. In addition, as an affected child ages and regrowth of the epiphysis occurs, physicians must ensure that epiphyseal growth is contained within the cavity of the hip bone (acetabulum) where the thigh bone (femur) and hip normally meet (articulate).
Nonsurgical treatment may include crutches or a special brace or cast to keep the ball of the joint completely within the socket (acetabulum) so that it will not deform while healing.
Surgical treatments may include various procedures designed to place and keep the ball within the socket. Surgery is done mainly to improve and preserve the shape of the hip joint in order to prevent or reduce the chances of arthritis later during life. A femoral or pelvic osteotomy is often performed. Osteotomy is a surgical procedure in which bone is cut to shorten, lengthen, or change the alignment (i.e. reposition or reorient the bone). Some adults may ultimately require a total hip replacement surgery (total hip arthroplasty) later in life due to osteoarthritis.
Physicians may rely upon specific classification systems to make certain decisions concerning treatment and predict an affected individual’s long-term progress. For example, the Stulberg Classification System, created in 1981, defines five outcome categories based upon the shape of the femoral head and its relationship with the hip socket (as seen upon x-ray imaging studies). However, the variability of the disease and long term follow up needed to understand the outcome of treatment have contributed to the lack of establishing a universal treatment strategy for children with this disorder.