Dawaa Reference

Clinical reference

Legg-Calve-Perthes disease

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Legg-Calve-Perthes Disease - StatPearls (NCBI Bookshelf NBK513230) - https://www.ncbi.nlm.nih.gov/books/NBK513230/ · Legg-Calve-Perthes disease - disease-level clinical article (perthes-disease-full.txt) · Legg-Calve-Perthes disease - disease-level clinical article (perthes-disease-clinical.txt) · MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified against4 documents
  • Legg-Calve-Perthes Disease - StatPearls (NCBI Bookshelf NBK513230) - https://www.ncbi.nlm.nih.gov/books/NBK513230/
  • Legg-Calve-Perthes disease - disease-level clinical article (perthes-disease-full.txt)
  • Legg-Calve-Perthes disease - disease-level clinical article (perthes-disease-clinical.txt)
  • MSF Essential Drugs 2024 (ibuprofen oral monograph)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • A painless or mildly painful limp in a 4 to 10 year old that worsens with activity and eases with rest is typical [limp]
  • Hip or groin pain that refers to the knee can misdirect the initial evaluation toward the knee [groin pain · hip pain]
  • The absence of fever or systemic illness helps separate this from an infectious cause of hip pain [groin pain · hip pain]
  • It is an avascular necrosis of the growing femoral head, with no cause ever found [necrosis]
  • Boys are affected far more often than girls

Signs — what you find (5)

  • An antalgic or Trendelenburg gait with restricted hip abduction and internal rotation is characteristic
  • A shortened leg on the affected side can result from femoral head collapse [collapse]
  • Both hips are affected in 15% to 20% of cases, sometimes with subtle early findings
  • The head of the femur can deform if it is not kept contained inside the socket
  • Red flag: a head that does not heal round and congruent risks femoroacetabular impingement and osteoarthritis early in life

Tests (4)

  • Early radiographs may look normal or show subtle epiphyseal density change, while later films show fragmentation and lateral pillar collapse
  • A crescent sign on X-ray marks a subchondral fracture
  • MRI can pick up marrow changes and lost blood supply earlier than plain X-rays can
  • Blood tests are typically normal and are mainly used to rule out infection or inflammatory arthritis

If not this — what else fits (3)

  • Fever or elevated inflammatory markers point away from Perthes toward septic arthritis, osteomyelitis, or inflammatory arthritis
  • Age at onset, the pattern of femoral head involvement, and systemic symptoms help separate Perthes from slipped epiphysis, transient synovitis, septic arthritis, or JIA
  • MRI is particularly useful to tell Perthes apart from transient synovitis, early slipped epiphysis, or infection

SourceLegg-Calve-Perthes disease - disease-level clinical article (perthes-disease-full.txt)

Presentation findings are traced to the source above.

Rx: Pain | Main treatment

PAIN

1

IBUPROFEN

Pain

1st line

Strength400 mg

Formoral.solid

Adult dose and duration

Legg-Calve-Perthes disease belongs to the 4-to-10-year-old, so the weight-based child dose is the one in use. For an adolescent of 12 years or over, or an adult: 200 to 400 mg 3 to 4 times daily, to a maximum of 1,200 mg in 24 hours, taken with food. - Short courses during painful phases, not continuously through the two to four years the disease runs.

Paediatric dose

5-10 mg/kg/dose [child max 400 mg]

(Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, to a maximum of 30 mg/kg in 24 hours. Nothing under 3 months of age. A single dose is capped at 400 mg, which is the adult single-dose maximum in the same MSF entry.)

Dose by weight
3kg15-30 mg/dose
4kg20-40 mg/dose
5kg25-50 mg/dose
6kg30-60 mg/dose
7kg35-70 mg/dose
8kg40-80 mg/dose
9kg45-90 mg/dose
10kg50-100 mg/dose
11kg55-110 mg/dose
12kg60-120 mg/dose
13kg65-130 mg/dose
14kg70-140 mg/dose
15kg75-150 mg/dose
16kg80-160 mg/dose
17kg85-170 mg/dose
18kg90-180 mg/dose
19kg95-190 mg/dose
20kg100-200 mg/dose
21kg105-210 mg/dose
22kg110-220 mg/dose
23kg115-230 mg/dose
24kg120-240 mg/dose
25kg125-250 mg/dose
26kg130-260 mg/dose
27kg135-270 mg/dose
28kg140-280 mg/dose
29kg145-290 mg/dose
30kg150-300 mg/dose
31kg155-310 mg/dose
32kg160-320 mg/dose
33kg165-330 mg/dose
34kg170-340 mg/dose
35kg175-350 mg/dose
36kg180-360 mg/dose
37kg185-370 mg/dose
38kg190-380 mg/dose
39kg195-390 mg/dose
40kg200-400 mg/dose
41kg205-400 mg/dose (upper capped)
42kg210-400 mg/dose (upper capped)
43kg215-400 mg/dose (upper capped)
44kg220-400 mg/dose (upper capped)
45kg225-400 mg/dose (upper capped)
46kg230-400 mg/dose (upper capped)
47kg235-400 mg/dose (upper capped)
48kg240-400 mg/dose (upper capped)
49kg245-400 mg/dose (upper capped)
50kg250-400 mg/dose (upper capped)
Dose source

MSF Essential Drugs 2024 (ibuprofen oral monograph)

Why

Most children with Legg-Calve-Perthes disease are managed without an operation at first, and the article's own list of initial measures is avoiding high-impact activity, relative weight-bearing restriction with crutches during painful phases, and short courses of a non-steroidal anti-inflammatory drug - ibuprofen is the example it gives - to reduce the pain and the synovitis. The article names the drug and no amount, so the amount is MSF's.

Cautions
  • Fever, redness, or raised inflammatory markers are not part of Perthes. Do not let an anti-inflammatory quieten the pain of a septic arthritis and delay it - the article's own differential for the limping child is transient synovitis, septic arthritis, juvenile idiopathic arthritis and a slipped capital femoral epiphysis.
  • The medicine treats the pain, not the disease. What decides the outcome is how round the femoral head is at skeletal maturity, and the containment decisions belong to paediatric orthopaedics.
  • Severe pain with markedly restricted hip movement is a reason to involve the specialist rather than to increase the dose - the article's answer there is short-term bed rest or in-hospital skin traction.
  • Not for a child under 3 months. MSF also contra-indicates ibuprofen in allergy to any NSAID, peptic ulcer, coagulation defects, haemorrhage, surgery carrying a risk of major blood loss, severe renal or hepatic impairment, severe heart failure, severe malnutrition, uncorrected dehydration or hypovolaemia, and severe infection.
  • Avoid in pregnancy. MSF contra-indicates it outright from the beginning of the sixth month and names paracetamol as the substitute. Short-term use while breast-feeding carries no contra-indication.
  • Give with caution to an older or an asthmatic patient. Do not combine it with methotrexate, with an anticoagulant, or with another NSAID, and watch the combination with a diuretic or an ACE inhibitor - MSF's instruction there is to drink plenty of fluids to avoid renal failure.
  • It may cause allergic reactions, epigastric pain, peptic ulcer, haemorrhage and renal impairment.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

MAIN TREATMENT

2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Legg-Calve-Perthes Disease - StatPearls (NCBI Bookshelf NBK513230) - https://www.ncbi.nlm.nih.gov/books/NBK513230/

Why

Legg-Calve-Perthes disease is a slow, painless-to-mildly-painful limp in a young child that ends in a deformed femoral head if containment is lost. Primary care recognises it and X-rays the hips; the containment decisions belong to paediatric orthopaedics. The anti-inflammatory below is for the pain and the synovitis. No medicine changes the course of the disease, and none is offered as if it did.

Cautions
  • THE PICTURE IS A YOUNG CHILD WHO LIMPS WITHOUT COMPLAINING MUCH - Perthes creeps up rather than announcing itself. What parents describe is a limp in a child of 4 to 10 years with little or no pain in it, worse after activity and better with rest.
  • AND THE PAIN IS OFTEN IN THE KNEE - where it hurts is usually the hip or the groin, and it commonly refers down to the knee, which is what sends the assessment off in the wrong direction. The history to take: pain in the hip, the groin, the thigh or the knee that comes on with activity - and sometimes knee pain and nothing else.
  • NO FEVER, NO ILLNESS - AND IF THERE IS, IT IS NOT PERTHES - there are no systemic signs in Perthes: no fever, no redness, no raised inflammatory markers. Find any of those and look instead for septic arthritis, for osteomyelitis, or for an inflammatory arthropathy.
  • WHAT TO FIND ON EXAMINATION - a gait that is antalgic or Trendelenburg. Hip movement restricted, abduction and internal rotation worst of all, with a flexion contracture and loss of full extension developing in time. Pain at the ends of the range, abduction and internal rotation again. And, once it has run a while, wasting of the thigh and the buttock.
  • X-RAY BOTH HIPS, AND ACCEPT THAT EARLY FILMS CAN BE NORMAL - the standard pair is an AP view of the pelvis and a frog-leg lateral. At the very earliest stage all there may be is a capital femoral epiphysis that looks slightly denser or smaller than its fellow, or an effusion in the joint - and the films can be entirely normal. MRI picks up early disease more readily than plain radiography does.
  • REFER EARLY, BECAUSE THE WINDOW IS THE SHAPE OF THE HEAD - parents, and whoever sees the child first in primary care, need telling that a limp which persists, or hip, groin, thigh or knee pain brought on by activity, warrants assessment without delay, hip films included. Diagnose it early and the containment strategies can start before the head has deformed badly.
  • WHAT THE SPECIALIST IS TRYING TO ACHIEVE - what decides the outcome years later is how round the femoral head is at skeletal maturity, and how well it fits the acetabulum. So the management aims to keep the femoral head contained within the acetabulum, or to get it back there, and to preserve the range of hip movement - abduction and internal rotation above all.
  • AGE AT ONSET IS THE BIGGEST PROGNOSTIC LEVER - a child under 6 years, and especially one whose disease is mild (Herring A, and some B), usually does well without an operation. A child over 8 years, and one whose head is more extensively involved (Catterall III-IV; Herring B, B-C or C), is at greater risk of a poor result and is likelier to gain from surgical containment, provided the hip still moves adequately.
  • TELL THE FAMILY HOW LONG IT TAKES BEFORE THEY ASK - explain that the natural history is a long one, typically 2 to 4 years, and that it means repeated films and repeated examinations. The family should grasp that the aim is a hip that is well shaped and lasts, not symptoms gone quickly.
  • IT IS NOT A BENIGN LIMP THAT WEARS OFF - Perthes heals itself, but that is not the same as harmless. What deformity remains shows as coxa magna, the femoral head enlarged; coxa plana, the head flattened; and a head no longer spherical on a shortened femoral neck with the offset reduced.
  • CHECK THE OTHER HIP TOO - both hips are involved in 10% to 24% of patients, though not necessarily at the same time. Where it is bilateral, the two sides may look alike or may follow one another, and early on the changes can be very slight.
  • THE OTHER LIMPING-CHILD DIAGNOSES TO HOLD BESIDE IT - the article's own differential is transient synovitis, septic arthritis, juvenile idiopathic arthritis, and a slipped capital femoral epiphysis. Age is the first sorter: Perthes belongs to the 4-to-10-year-old, a slipped capital femoral epiphysis to the heavier adolescent. Both send their pain to the knee.
  • SMOKE IS THE ONE RISK A FAMILY CAN ACT ON - counsel families firmly to keep the child away from tobacco smoke, in pregnancy and through childhood.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.