Legg-Perthes disease

[steenkh]

I have a nephew who had Legg-Perhtes disease. When he was about 6 years, he started having pains in his legs, and he was diagnosed to have Legg-Perthes disease.

This disease consists of a malforming of the hip, which some children can outgrow and become healthy again.

His treatment consisted only in having crutches and not allowing him to participate in physical actions, which is very hard for a boy at that age.

I think it was about a year later that the doctors decided that surgery was needed because the bones were getting worse, and not better. He lives in Austria, and his parents took him to Germany to consult a renowned specialist there. The result was the same, and surgery was recommended.

In desperation the parents went to a healer, and I am a little unsure exactly what the healer did, but I think it was some kind of massage, possibly reflexiology.

Within half a year, the crutches could be put away, and later the doctors pronounced him completely healthy after a miraculous healing.

Now, I have noticed that there are some doctors present on this forum, and I would like to ask:

Is it possible that two different doctors, both experts, could have been wrong about the disease getting worse?

Can this disease go away of itself after an initial worsening?

Woo-woo medicine has got a big boost in our Austrian family after this incident, and I do see the point, but before I surrender and accept this one practitioner not to be a complete fake, I would like to hear some opinions.

 

[Benguin]

Has the disease gone away or has the patient been able to cope with the discomfort better?

 

[steenkh]

Today he is doing the activities of a normal child: football, skateboarding etc. He has been checked by the doctors and pronounced healthy.

 

[Rolfe]

I didn't realise humans got this! (Note to self, when a disease is named after a person, it's always a human disease.) Avascular necrosis of the femoral head.

I've looked it up and it seems to be a bit different in humans, perhaps because of the bipedal locomotion. But I think it does get a lot better on its own, depending on how the femoral head heals. Then there's a danger of arthritis developing in later life, particularly if the healed hip isn't too good a fit. Recommendations for surgery may be as much to do with minimising the potential for middle-aged arthritis as restoring function in the short term - the latter is probably going to happen anyway. And I note that the texts dealing with the disease in humans seem to recommend physiotherapy, so how much of that got dressed up as reflexology?

I wonder how much the telling of the story is exaggerating the bit about the doctors saying it was a "miraculous healing".

Rolfe.

 

[steenkh]

I wonder how much the telling of the story is exaggerating the bit about the doctors saying it was a "miraculous healing".

You wonder rightly! I did not actually quote anybody, but just cited from my memory, and I think that "remarkable" would have been a better term.

Anyway, the story is second hand, because I only heard it from the parents, and I do not know exactly what the doctors or the healer said. The story is some six years old, and I had some discussions with the parents when they announced that they would seek a healer. They countered my arguments with "What is left for us to do?", and I have sinced backed out so as not to cause any disharmony in our relationship.

Now that you mention physiotherapy, I think I remember that there were also some physical exercise involved.

In little more than a month, I shall see the boy and his family again, and I can enquire what exactly the healer did. If there is anything new, I can bump the thread then.

 

[Benguin]

And I note that the texts dealing with the disease in humans seem to recommend physiotherapy, so how much of that got dressed up as reflexology?

I've had long and persistent problems with ankles, knees, hips etc due to very flat feet. Not long ago I had the dubious privilege of a friend asking me if I'd be one of her case studies on her reflexology course.

I think she knows I'm skeptical on such things and might have selected me for that reason. And I'm certainly not going to turn down free foot rubs.

I found that the few weeks of foot rubbing helped immensely with my very sore feet, particularly the pain caused when I use splints in my shoes, consequently I've less ankle and knee problems. I'd speculate the risks of future arthritis may be diminished.

Now I wrote about this in some detail for her, as the improvement seems to have been permanent (ie, didn't revert as soon as weekly massages stopped). Also noticeable and incredibly beneficial.

As it was clear that the most likely explanation was a result of a massage/physiotherapy style phenomenon rather than altering my flow of chi, the uninterest was deafening! I think she'd been trying to solve my allergies and arthritic thumbs with her course.

The point of that anecdote is that I was actually quite surprised at what happened, and pleased. I wouldn't have predicted how much easier and less painful walking (say) would become after some simple relaxation and massage. However the reflexologists seemed totally uninterested in learning more about how their art could be genuinely helpful as the explanations were so un-woo. Sad really.


Of course, extrapolating my experience to that of your relative would not be right ... we don't even know for sure what alt-med he received.

 

[Deetee]

Not my field, but my understanding is that this disease eventually improves as the child gets older. This may explain the resolution with alt meds, but I don't know why surgery may have been suggested in the first place.

 

[Rolfe]

Not my field, but my understanding is that this disease eventually improves as the child gets older. This may explain the resolution with alt meds, but I don't know why surgery may have been suggested in the first place.

Possibly to minimise the probability of the patient going on to develop arthritis in middle age.

It's perfectly possible everyone thought that would be the best plan, but in fact the condition cleared up better than expected - maybe with a bit more physiotherapy.

Rolfe.

 

[Pantastic]

I didn't realise humans got this!

And I didn't realise animals got it!
A nice bit of knowledge exchange.

Mild or moderate disease often improves with bed rest and x-ray monitoring to check the condition of the joint. More severe cases usually need surgery, but the cut off point for moderate disease from needing simple bed rest to needing surgery is fuzzy. It may well have been the case that surgery was considered, but the condition improved with bed rest and this was then not needed.

Shame a 'healer' had to take credit and money for the disease following it's natural course, but that's what they do.

 

[Rolfe]

And I didn't realise animals got it!
A nice bit of knowledge exchange.

The first links Google came up with when I loked were all about the disease in dogs. It's hereditary in certain breeds. Bed rest doesn't go down well with Labrador puppies, but fortunately quadrupeds the size of dogs can get along very well without the femoral head at all, and form a sort of false joint with muscle tissue.

But still, a lot of the mildly affected ones get better without surgery.

Rolfe.

 

[Benguin]

Is the one that commonly befalls guide dogs then?

 

[Rolfe]

Is the one that commonly befalls guide dogs then?

No I don't think so, because they're pretty picky about what they breed from in the GDBA.

Rolfe.

 

[TeaBag420]

I have a nephew who had Legg-Perhtes disease. ... which some children can outgrow and become healthy again.

.....

Is it possible that two different doctors, both experts, could have been wrong about the disease getting worse?

Can this disease go away of itself after an initial worsening?

The first question: yes, it's possible for more than one person to be wrong about something.

The second question: according to your own assertion, yes.

 

[steenkh]

Re: Re: Legg-Perthes disease

The first question: yes, it's possible for more than one person to be wrong about something.

The second question: according to your own assertion, yes.

I agree that I could have framed the questions in a more unambiguous way, but most people would know that I did not ask for the obvious.

But thanks to those that provided an answer.

 

[Badly Shaved Monkey]

Is the one that commonly befalls guide dogs then?

Need to correct Rolfe on this one (head in a test tube and all that ). Legg-Perthes is a disease of little breeds. Nothing's impossible, but big dogs just don't get it. I've always vaguely though that it must be due to the small size of the femoral head, but that can't be right because you don't see it in cats, or indeed mice, yet you do see it in people. Maybe its another one of those things that we have in certain breeds because it was there in the orginal small genetic pool that created them and many of the small breeds come from a common stock, or maybe it could be due, not to the absolute size of the breed, but the process of making a big wolf into a Yorkshire terrier, forcing development down an abnormal path (the reason I add that is because I think it occurs in all small breeds, yet Chihuahuas and terriers have separate origins AFAIK, so the probability of having a genetic fault common to all these lines seems unlikely).

The big dog problem is usually hip dysplasia, a whole different process involving deformity of femoral head and acetabulum that seems to orginate in discrepant growth between the soft tissues of the body and the developing skeleton. Big fleshy puppy, tiny plastic skeleton. Their hips are anatomically normal at birth then the femoral head and acetabulum gradually lose congruity in the first few weeks of life, so that by the time you buy a puppy at 6-8wks the process is already active and the only control you have is not to over-exercise them or get them fat, [getsonsoapbox] which is why breeding for low hip scores is so important, but breeders are too selfish to do it properly[/getsonsoapbox]

Also, I don't think anyone's (including Pantastic) quite nailed the main point about L-P which is that the disease has no possible outcome except spontaneous resolution of the pathological process. Where the uncertainty comes in is what happens to the hip joint during and after the active necrotic phase: is it merely a painful, but ultimately inconsequential event in development; is enough damage done to create osteoarthritis and that is then a self-perpetuating process once initiated; is the necrosis so bad that the femoral head falls to pieces. So L-P always goes away. The future is dictated by the presence or absence of these sequelae.

 

[Rolfe]

Need to correct Rolfe on this one (head in a test tube and all that ). Legg-Perthes is a disease of little breeds.

[Momentarily removes head from test-tube.] Sorry! Don't know what made me say Labradors. Is there a blushing smilie?

Also, I don't think anyone's (including Pantastic) quite nailed the main point about L-P which is that the disease has no possible outcome except spontaneous resolution of the pathological process. Where the uncertainty comes in is what happens to the hip joint during and after the active necrotic phase: is it merely a painful, but ultimately inconsequential event in development; is enough damage done to create osteoarthritis and that is then a self-perpetuating process once initiated; is the necrosis so bad that the femoral head falls to pieces. So L-P always goes away. The future is dictated by the presence or absence of these sequelae.

Sorry, I wasn't clear enough because you're right, I'm not an orthopod and this isn't something I'm terribly familiar with as regards the long-term follow-through. But it did strike me that the surgery was probably suggested to improve the long-term outcome - whether or not he gets debilitating arthritis in his forties.

It may be that in fact the hip healed up much better than was expected - this isn't a great surprise really. On the other hand maybe we won't really know for many years whether the child has really come off unscathed from this one.

Rolfe.