What is Coxa Plana?
not allowing time for the  Blood tests
 Legg-Calve-Perthes
disease; Perthes
disease
 Is a degenerative
disease of the hip joint,
where growth/loss of
bone mass leads to
some degree of
collapse of the hip joint
and to deformity of the
ball of the femur and the
surface of the hip
socket. The disease is
characterized by
idiopathic avascular
osteonecrosis of the
capital femoral
Symptoms
epiphysis of the femoral
head leading to an
interruption of the blood
supply of the head of
the femur close to the
hip joint.
Risk Factors
 Occurs most frequently
in boys 3 to 12 years
old.
 Caucasians are affected
more frequently than
other races
 Males are affected 3-4
times more often than
females
Causes
Diagnostic Test
 Although no-one has
identified the cause of
Perthes disease it is
known that there is a
reduction in blood flow
to the joint. It is thought
that the artery of the
ligamentum teres
femoris closes too early,
medial circumflex
femoral artery to take
over.
 For example, a child
may be 6 years old
chronologically but may
have grown to 4 years
old in terms of bone
maturity. The child may
then engage in activity
appropriate for a child of
6 but may not yet have
the bone strength of an
older child, leading to
flattening or fracture of
the hip joint.
 Knee pain (may be the
only symptom, initially)
 Persistent thigh or groin
pain
 Atrophy (wasting) of
muscles in the upper
thigh
 Slight shortening of the
leg, or legs of unequal
length
 Hip stiffness restricting
movement in the hip
 Difficulty walking,
walking with a limp
(which is often painless)
 Limited range of motion
 X-rays
 Bone scans
 Magnetic Resonance
Imaging (MRI)
 Arthrograms - a
diagnostic imaging test
to study the non-bony
structures of joints.
 Erythrocyte
sedimentation rate -
elevated if infection
present
 Treatment
 The aim of treatment is
to protect the bone and
joint from further stress
and injury while the
healing process takes
place.
 rest
 activity restrictions
 medications
 bed rest and traction
 casting or bracing (to
hold the femoral head in
the hip socket, permit
limited joint movement,
and allow the femur to
remold itself into a
round shape again)
 physical therapy (to
keep the hip muscles
strong and to promote
hip movement)
 crutches or wheelchair
(in some cases)
 Surgery
 surgery (to hold the
femoral head in the hip
socket)
 Inominate osteotomy;
varus osteotomy;
osteotomy of the
proximal femur,
acetabulum (Salter
innominate), or a
combination of these
may be required
 Other than surgery;
NSAIDs such as Motrin
help with the pain
inflicted.
Phases of Perthes Disease Complications
 Phase 1:  Osteoarthritis may
Necrosis - Blood develop later in life,
supply is absent to the although the
femoral head and the development of
hip joint becomes osteoarthritis may be
inflamed, stiff, and minimized with prompt
painful. Portions of the recognition and proper
bone turn into dead treatment.
tissue. The ball of the
thigh bone becomes Prognosis
less round in  The outcome is usually
appearance on x-rays. good with treatment.
This phase can last Most bone will heal with
from several months up minimal lasting
to one year.
deformity.
 Phase 2:  Children younger than 6
Fragmentation - The have the best prognosis
body cleans up the since they have time for
dead bone cells and the dead bone to
replaces them with new, revascularize and
healthier bone cells. remodel. Children that
The femoral head have been diagnosed
begins to remodel into a with Perthes' Disease
round shape again. The after the age of 10 are
joint is still irritated and at a very high risk of
painful. This phase can developing
last from one to three osteoarthritis
years.
 Phase 3:
Reossification - The Reported by:
femoral head continues Jay Francis Corcelles
to model itself back into Melson Flores
a round shape with new
bone. This phase lasts
for one to three years.
 Phase 4: Remodeling -
Normal bone cells
replace the new bone
cells and the
remodeling continues.
This last phase can last
a few years to complete
the healing process.