Legg-Calvé-Perthes Disease

Description

Legg-Calvé-Perthes disease is a disorder of the capital femoral epiphysis caused by varying degrees of ischemia, resulting in avascular necrosis of the femoral head. It most commonly affects boys between 4 and 8 years of age and is often associated with delayed skeletal maturation.

The disease progresses through several stages, beginning with avascular necrosis, followed by fragmentation and abnormal growth of the epiphysis, and finally revascularization, regeneration, and remodeling of the femoral head.

Symptoms

Pain is typically first felt in the knee because it is referred from the hip, and the child develops a limp. The affected hip has restricted abduction, adduction, and rotation. As the disease progresses, pain also develops in the hip and groin. Symptoms usually worsen toward the end of the day and improve after overnight rest. Temporary pain-free intervals are common. Despite limping, the child’s general condition is usually good, and normal activity is often maintained.

Diagnosis

The diagnosis is based on the medical history, clinical examination, and imaging studies. Blood tests are typically normal. Plain radiographs and computed tomography (CT) may demonstrate a flattened, fragmented, or sclerotic femoral head.

Treatment

Early treatment is essential. Management includes protected weight-bearing, traction when indicated, and comprehensive physical therapy. Weight-bearing should be avoided until adequate reossification has occurred to reduce the risk of femoral head collapse and deformity. Treatment usually lasts approximately 2–4 years. Inadequate treatment may result in limb length discrepancy, hip osteoarthritis (coxarthrosis), and other complications.

Conservative treatment is generally recommended for children younger than 5 years of age and aims to preserve hip range of motion, often using an abduction brace or traction device. Surgical treatment may be indicated in children older than 6 years when the femoral head is no longer spherical. Surgical options include femoral osteotomy, pelvic osteotomy, and, in severe cases, arthrodesis.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology