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LEGG CALVÉ PERTHES DISEASE
by Fred Lanting
Copyright September, 2006 -
A disorder sometimes easily mistaken for hip dysplasia is Legg-Calvé-Perthes disease, perhaps more frequently referred to by the dog fancier as "Legg-Perthes". This is an aseptic (not infected), developmental necrosis (dying of tissue) of the femoral head and neck, found almost entirely in toy or other small breeds. On radiographs, it often looks as if the bone is "rotting away", and lameness is the major or only symptom. It has a history in human medicine, too. In fact, that's where it was first discovered in 1910 by three researchers working independently. Legg, Calvé, and Perthes each saw a flattening of the femoral head (coxa plana) in affected youngsters and thought that trauma was at the heart of its etiology.
Schnelle in the 1930s first saw the disorder in the canine in Wirehaired Fox Terriers, and Moltzen-Nielsen in Germany about the same time saw it mostly in the Wires but also in a few other breeds Since then puppies between 3 and 10 months, of many other small, toy, and miniature breeds have been affected.
Radiographic ("X-ray") signs of Legg-Perthes are usually gross and the course and outcome discouraging, since many cases are not referred to the vet or the specialist for diagnosis until the dog has been limping for a long time or the disease has progressed to the point that it becomes a more real problem to the owner. These small dogs put so little weight on their tiny hip joints that they almost can compensate for discomfort by "walking on their forelimbs instead of their four limbs". Many are "couch potatoes" or spend much time being carried, but even then, picking up an affected dog in a certain manner can put more pressure on the joint than does normal locomotion, so pain at that time is often the stimulus to do something about it. Owners have reported "incredible pain" and constant, progressive discomfort, inability to stay long in any one position, and bone lysis (loss through a process akin to dissolving or consuming) at other areas in the limb distal to the hip (further away, the opposite of proximal).
The earliest radiographic signs, should you look for them before they change, include an increased radiodensity (opacity as seen on the radiograph) in the lateral part of the epiphysis of the femoral header Lateral means the part away from the mid-line or medial; the "outside". Resorption of necrotic (dying, rotting or decomposing) trabecular bone cells is next accompanied by a lysis (dissolving or being consumed) of bone. These are replacement attempts by the body, similar to the attempt to replace bone that takes place during HD remodeling; eventually there is fracture or collapse, like a frame house riddled by termites. As HD may or may not be concurrent, the congruity of the ball-and-socket coxofemoral joint might still be maintained until collapse.
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Fred Lanting is an internationally respected show judge, approved by many registries as an all-breed judge, has judged numerous countries’ Sieger Shows and Landesgruppen events, and has many years experience with SV. He presents seminars and consults worldwide on such topics as Gait-&-Structure, HD and Other Orthopedic Disorders, Anatomy, Training Techniques, and The GSD. He conducts annual non-profit sightseeing tours of Europe, centered on the Sieger Show (biggest breed show in the world) and BSP.
All Things Canine -- consulting division, Willow Wood Services Phone: 256-498-3319 Fax: 256-498-3311 E-mail mr.gsd@netscape.com
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