Coxa PlanaCoxa Plana

Reported by:Reported by:

Jay Francis CorcellesJay Francis Corcelles

Melson FloresMelson Flores

What is Coxa Plana?What is Coxa Plana?

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 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 FactorsRisk Factors

Occurs most frequently in boys 3 to 12 Occurs most frequently in boys 3 to 12 years old. years old.

Caucasians are affected more frequently Caucasians are affected more frequently than other racesthan other races

Males are affected 3-4 times more often Males are affected 3-4 times more often than females than females

CausesCauses Although no-one has identified the cause of Perthes Although no-one has identified the cause of Perthes

disease it is known that there is a reduction in blood disease it is known that there is a reduction in blood flow to the joint. It is thought that the artery of the flow to the joint. It is thought that the artery of the ligamentum teres femoris closes too early, not ligamentum teres femoris closes too early, not allowing time for the medial circumflex femoral artery allowing time for the medial circumflex femoral artery to take over.to take over.

For example, a child may be 6 years old For example, a child may be 6 years old chronologically but may have grown to 4 years old in chronologically but may have grown to 4 years old in terms of bone maturity. The child may then engage terms of bone maturity. The child may then engage in activity appropriate for a child of 6 but may not yet in activity appropriate for a child of 6 but may not yet have the bone strength of an older child, leading to have the bone strength of an older child, leading to flattening or fracture of the hip joint. flattening or fracture of the hip joint.

SymptomsSymptoms

Knee pain (may be the only symptom, initially) Knee pain (may be the only symptom, initially) Persistent thigh or groin pain Persistent thigh or groin pain Atrophy (wasting) of muscles in the upper thigh Atrophy (wasting) of muscles in the upper thigh Slight shortening of the leg, or legs of unequal Slight shortening of the leg, or legs of unequal

length length Hip stiffness restricting movement in the hip Hip stiffness restricting movement in the hip Difficulty walking, walking with a limp (which is Difficulty walking, walking with a limp (which is

often painless) often painless) Limited range of motion Limited range of motion

Diagnostic TestDiagnostic Test

X-rays X-rays Bone scans Bone scans Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging (MRI) Arthrograms - a diagnostic imaging test to Arthrograms - a diagnostic imaging test to

study the non-bony structures of joints. study the non-bony structures of joints. Blood tests Blood tests Erythrocyte sedimentation rate - elevated if Erythrocyte sedimentation rate - elevated if

infection presentinfection present

TreatmentTreatment The aim of treatment is to protect the bone and joint from further The aim of treatment is to protect the bone and joint from further

stress and injury while the healing process takes place.stress and injury while the healing process takes place. rest rest activity restrictions activity restrictions medications medications bed rest and traction bed rest and traction casting or bracing (to hold the femoral head in the hip socket, casting or bracing (to hold the femoral head in the hip socket,

permit limited joint movement, and allow the femur to remold permit limited joint movement, and allow the femur to remold itself into a round shape again) itself into a round shape again)

physical therapy (to keep the hip muscles strong and to physical therapy (to keep the hip muscles strong and to promote hip movement) promote hip movement)

crutches or wheelchair (in some cases)crutches or wheelchair (in some cases)

SurgerySurgery

surgery (to hold the femoral head in the surgery (to hold the femoral head in the hip socket) hip socket)

Inominate osteotomy; varus osteotomy; Inominate osteotomy; varus osteotomy; osteotomy of the proximal femur, osteotomy of the proximal femur, acetabulum (Salter innominate), or a acetabulum (Salter innominate), or a combination of these may be requiredcombination of these may be required

Other than surgery; NSAIDs such as Other than surgery; NSAIDs such as Motrin help with the pain inflicted. Motrin help with the pain inflicted.

Phases of Perthes Phases of Perthes DiseaseDisease

Phase 1:Phase 1: NecrosisNecrosis - Blood supply is absent to the - Blood supply is absent to the

femoral head and the hip joint becomes femoral head and the hip joint becomes inflamed, stiff, and painful. Portions of the bone inflamed, stiff, and painful. Portions of the bone turn into dead tissue. The ball of the thigh bone turn into dead tissue. The ball of the thigh bone becomes less round in appearance on x-rays. becomes less round in appearance on x-rays. This phase can last from several months up to This phase can last from several months up to one year. one year.

Phase 2: FragmentationPhase 2: Fragmentation - The body cleans up the dead - The body cleans up the dead bone cells and replaces them with new, healthier bone bone cells and replaces them with new, healthier bone cells. The femoral head begins to remodel into a round cells. The femoral head begins to remodel into a round shape again. The joint is still irritated and painful. This shape again. The joint is still irritated and painful. This phase can last from one to three years. phase can last from one to three years.

Phase 3: ReossificationPhase 3: Reossification - The femoral head continues to - The femoral head continues to model itself back into a round shape with new bone. This model itself back into a round shape with new bone. This phase lasts for one to three years. phase lasts for one to three years.

Phase 4: RemodelingPhase 4: Remodeling - Normal bone cells replace the new - Normal bone cells replace the new bone cells and the remodeling continues. This last phase bone cells and the remodeling continues. This last phase can last a few years to complete the healing process. can last a few years to complete the healing process.

ComplicationsComplications

Osteoarthritis may develop later in life, Osteoarthritis may develop later in life, although the development of although the development of osteoarthritis may be minimized with osteoarthritis may be minimized with prompt recognition and proper treatment. prompt recognition and proper treatment.

PrognosisPrognosis

The outcome is usually good with treatment. The outcome is usually good with treatment. Most bone will heal with minimal lasting Most bone will heal with minimal lasting deformity. deformity.

Children younger than 6 have the best Children younger than 6 have the best prognosis since they have time for the dead prognosis since they have time for the dead bone to revascularize and remodel. Children bone to revascularize and remodel. Children that have been diagnosed with Perthes' that have been diagnosed with Perthes' Disease after the age of 10 are at a very high Disease after the age of 10 are at a very high risk of developing osteoarthritisrisk of developing osteoarthritis