# Legg-Calve-Perthes disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text LEGG-CALVE-PERTHES DISEASE 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) Review status: REVIEWED against 4 sources listed above (2026-08) 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 Source Legg-Calve-Perthes disease - disease-level clinical article (perthes-disease-full.txt) Status traced to the source above Rx: Pain | Main treatment PAIN 1. IBUPROFEN [1st line] Adult 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. Peds 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.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) 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. Caution 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. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)