Legg-Calve-Perthes Disease
This condition is also known as Legg-Perthes disease, Perthes disease, coxa plana, and aseptic or avascular necrosis of the femoral head.
Legg-Calve-Perthes Disease (LCP) causes a lack of blood flow to the femoral head within the hip which causes necrosis and severe lameness. This is (mostly) a genetic condition however in rare cases can be caused by trauma or injury to the leg or hip. This condition can be more-commonly found in some smaller breeds such Dachshunds, Pugs, West Highland Terriers, Chihuahuas, Poodles, Pomeranians, Yorkshire terriers and Bichon Frises. The condition is progressive and can become very painful for the dog, the disease process is not yet fully understood however has been confirmed to be hereditary.
Symptoms
Lameness that gradually gets more severe
Licking or chewing over the hip
Muscle atrophy
Stiffness in one or both hind-limbs
Reclusiveness, restlessness or lethargy
Anxiety or aggressive behaviour
Pain on manipulation of the hip
Grating or popping when the hip is manipulated
The signs of LCP first starts with a mild lameness which gradually gets worse over time. As it begins to progress the pain and stiffness becomes more prominent and muscle atrophy will develop. The dog will eventually get to the stage where they will completely stop weight bearing on that limb due to severe pain and weakness.
How is LCP disease diagnosed?
The symptoms of LCP can look like the classic signs for early onset osteoarthritis or hip dysplasia . A veterinarian will make a diagnosis based on a thorough clinical examination and x-rays.
Grade 1: The first radiographic sign to appear is a widened joint space; early in the course of the disease, areas of decreased density may also be noted in both the proximal femoral epiphysis and metaphysis.
Grade 2/3: With disease progression, flattening and irregularity of the femoral head become apparent; more numerous areas of decreased opacity may bring a lytic appearance to the femoral head and neck.
Grade 4: A more accentuated flattening and irregularity of the femoral head and neck, caused by collapse and remodeling of the affected bone, may lead to widening and subluxation of the coxofemoral joint space.
Grade 5: In the advanced stages, fragmentation of the femoral head and discontinuity of the articular surface may occur.
Ljunggren, G. Legg-Perthes disease in the dog. Acta Orthop Scand 1967;95(Suppl):22-26.
How is LCP disease treated?
In milder cases the veterinarian may begin treatment for conservative management through pain medication, anti-inflammatories, rest and physiotherapy. In more extreme cases this disease will progress and will require surgery in the form of a femoral head and neck excision, which removes the ball part of the bone so it cannot rub on the acetabulum of the hip and cause pain. Larger dogs with LCP disease may require a total hip replacement
Prognosis of dogs with LCP disease?
There is a good prognosis for dogs who undergo surgery however rehabilitation and physiotherapy is essential for the dog to help build up muscle and create the ‘false joint’ where the femoral head used to be. Dogs with extreme muscle atrophy will need more time to recover and rebuild strength, therefore it is advised to perform the surgery if your dog has an early diagnosis to aid in quicker recovery.
Physiotherapy will be required whether you opt for conservative management in mild cases to help with compensatory muscle abnormalities or if you undergo surgery. The surgical procedure removes the femoral head to create a false joint therefore needs supporting with the correct build up of muscle mass.
How to prevent LCP
It is very difficult to prevent this condition if your dog is genetically pre-disposed however as responsible breeders it is very important to not breed from dogs with LCP and make sure that you test your dog before breeding from it. If you are buying a dog, check with the breeder that the parents have had their hips checked by the vet.
Prevent your dog from becoming overweight
Routine check-ups with the veterinarian
Spay and Neuter dogs who have had LCP disease.
A typical post-operative approach to LCP disease management.
Anti- inflammatory (NSAID) medication and pain relief from the veterinarian
Joints are put through a slow range of motion
Cold therapy over the surgical site to reduce inflammation, swelling and pain
TENS may be used as additional pain relief
Range of motion exercise is extended
Therapeutic laser therapy to reduce swelling and help with pain management
Assisted walking with a sling under the abdomen to encourage limb motion and weight-bearing
Weight shifting exercises onto the hindlimbs
`Heat pack applied after 72hrs post-surgery prior to physiotherapy to warm muscles
Stretching of the limbs to increase range of morion
Walking on a ground treadmill (if possible)
Sit to stand exercises
Walking up inclines
Balance exercises on a wobble cushion
Proprioceptive aid on the effected limb to encourage use (such as hair scrunchies)
Polework to increase muscle mass
Hydrotherapy
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