Dr.  Ratnav Ratan explains Legg- Calve Perthes Disease in Children

 
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Between the ages of 3 and 15, Legg-Calve-Perthes disease affects one or both of a child's hips. It's also known as Perthes or LCPD. The leading cause of Legg-Calve-Perthes disease is blood loss to the femoral head in the femur.

How can you tell if your child has Perthes disease?

According to Dr. Ratnav Ratan, a renowned pediatric orthopedic surgeon in Gurgaon, it helps to keep a close eye on a child's stride, especially when they're playing or participating in athletic activities. Limping or an irregular running pattern can suggest hip or hip joint problems. The young one may also experience pain in the groin, hip, knee, and thigh. Pain intensity increases with exercise and decreases with rest. The irritation causes the little one to endure painful spasms in the hip muscles. This painful ailment may persist for an extended period before the
little one is treated correctly for it.

Diagnosis of Perthes disease

To diagnose the Perthes condition, the orthopedic surgeon will perform a physical examination and obtain the child's medical history as well as x-rays. The young one's hip movement and range of motion will be thoroughly examined.

What happens when someone has Perthes disease?

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There is a lack of blood supply to the femoral head for unclear reasons, and a part of the femoral head bone dies. The term "necrotic bone" refers to a dead bone. Because there are no signs, the young one is completely oblivious of the loss. After a few years of this loss, the body attempts to create a new bone and heal the femoral head by absorbing the dead bone. The Legg-Calve-Perthes illness is caused by the body's natural course and healing period to repair the loss of blood supply to the femoral head.

Another explanation proposes that the loss of blood supply to the femoral head is due to trauma that damages blood vessels or causes blood clots, resulting in vein obstruction.

Dr. Ratnav Ratan says that in kids with one damaged hip, the chances of the other femoral head being impacted by Perthes disease are meager.

Because the little one and the primary family are not aware of the start of this ailment and the delay in diagnosis, the pediatric orthopedic doctor believes that early treatment is critical. Furthermore, children with Perthes disease who receive early and appropriate therapy can develop, play and live normally.

LCPD illness treatment

Based on the child's hip discomfort and stiffness and the degree of the collapse of the head of the thighbone, Dr. Ratnav Ratan  will conduct an in-depth evaluation and diagnosis of the hip issue and then prescribe the most appropriate treatment.

The following factors influence how LCPD is treated:

• The child's age

• The hip joint's range of motion

• The severity of the child's LCPD

Treatments for Legg-Calve-Perthes disease that aren't surgical

The orthopedic surgeon will most likely recommend

• Limited activities.

• traction and bed rest

• Medicines that reduce inflammation

For the following purposes, bracing or casting is used:

• To reduce the joint movement's actions.

• To keep the thighbone's head in its socket and

• To allow the thighbone to remold itself into the desired spherical shape.

How might bracing and casting help with LCPD treatment?

Another small operation is tenontomy, which is used to relieve the groin's abnormally tight adductor longus muscle, which prevents the hip from turning correctly. The orthopedic surgeon puts a very thin device to loosen the muscle.

The use of an A-frame as a conservative treatment option for Perthes disease

The orthopedic surgeon will employ Petrie casts, which are 2 lengthy leg casts with a bar to help hold the legs apart and treat the issue non-surgically. The legs are arranged in the shape of the letter 'A.'

A tenotomy surgery is performed by the orthopedic surgeon, which entails severing a tight groin tendon. After that, an A-shaped frame — 2 casts joined by a bar – is used to keep the legs apart. This procedure necessitates the use of an operating room.

In addition, arthrograms are specific x-rays used to determine the extent of deformity and the probability of correctly positioning the femoral head. As a result, the technique for taking arthrograms is done in an operating room. During the treatment, a specific dye is injected into the hip joint in modest volumes to help visualize the femoral head.

Physiotherapy to strengthen the damaged hip muscles and improve hip mobility.

LCPD surgical therapy

If non-surgical treatments have not given the expected outcomes, Dr. Ratnav Ratan may prescribe surgery to ensure that the head of the thighbone remains in the hip socket. After the age of six, it is indicated for children with LCPD. Also, if the femoral head has more than fifty percent injury, maintain proper bone formation for the essential functionality.

Osteotomy of the Pelvic and Femoral Bones

Femoral osteotomy is a surgical operation in which a pediatric orthopedic surgeon manipulates the femur (thighbone) and socket to accommodate the femoral head. The femur is cut and modified if necessary to ensure proper alignment, and the femoral head is seated correctly in the hip socket and secured with screws and a metal plate. After the little one has recovered from the sickness, the screws and the metal plate are removed. The little may additionally require pelvic osteotomy or shelf surgery in addition to the femoral osteotomy.

To keep the alignment after a femoral osteotomy, the little one must wear a cast for several weeks. Physiotherapy is essential to restore range of motion and muscular strength after removing the cast. To limit weight bearing on the afflicted hip, the young one will need to walk with a walker or crutches.

If Perthes disease appears later in life, such as after 9 years of age, conservative therapy and tried, surgical techniques are unlikely to achieve the intended effect. The goal is to alter the form of the femoral head or lessen the amount of pressure in the hip joint. Also, to treat this debilitating hip disease, the orthopedic surgeon may use a mix of treatments.

The condition of hinge abduction, in patients with LCPD

A child suffering from hinge abduction will experience shortening and pain. Because of the avascular necrosis, the child will have aberrant hip mobility. The acetabulum is not able to glide due to the malformed femoral head. Arthrodesis is recommended by orthopedic surgeons to treat this disease.

Early transphyseal neck-head drilling is used to treat hip abduction, and wearing an abduction brace is recommended at this time. Also, a transphyseal neck-head drilling can prevent the emergence of Perthes disease in the opposite hip, especially at the necrotic stage, when the disease has not yet impacted the joint.

Revascularization commences after the drilling technique, starting in the surrounding region and going to the centre. While healing can be seen in the necrotic zone's surrounding sections, it begins at the centre. 

According to Dr. Ratnav Ratan, children with LCPD who are treated may experience hip problems later in life; therefore, they must have regular orthopedic exams until they are adults.