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Current
Chapter:
Legg-Calvé-Perthes Disease (Updated August 2004)
Legg-Calvé-Perthes disease is a disorder of the hip caused by necrosis of the femoral epiphysis in children. This condition usually occurs between the ages of 4 to 8 years, but has been reported in children as young as 2 years of age. The child usually presents with a limp and complains of pain in the hip or knee area. The cause of this disease is unknown. Many theories have been introduced including infection, bacilliary embolism, coagulopathy, and trauma.
The sequential progression of the disease can be described through four stages: necrosis, re-sorption, re-ossification, and remaining growth. In the initial stage, the bony epiphysis becomes necrotic, ceases growth, and may develop a subchondral fracture. The second stage, or re-sorption phase, a portion of the necrotic bony epiphysis is removed by ingrowth of new blood vessels. At this stage there are areas of increased lucency observed on radiographs giving the appearance of a fragmented femoral head. A subcondral fracture may occur leading to the radiolucent zone which is one of the early indicators of Legg-Calvé-Perthes disease in the re-sorption stage. Collapse of the femoral head occurs leading to abnormal sphericity of the proximal femoral epiphysis. In the reossification phase, viable bone replaces the necrotic areas of the femoral had. The shape of the femoral head becomes stable in this stage. The final stage, or stage of remaining growth, is the residual deformity of the proximal femur from the disease process.
The primary objective in treating Legg-Calvé-Perthes disease is to prevent deformity of the hip which leads to degenerative joint abnormalities. The first principle of treatment is restoration of motion. Increasing joint motion enhances synovial and cartilage nutrition. This can be accomplished by progressive abduction, traction, or bed rest. Containment of the femoral head in the acetabulum has been the main objective in treating patients with a high risk of deformity, hinge abduction, and subluxation. Containment is an attempt to position the weightbearing area of the necrotic femoral head into the depths of the acetabulum. Containment of the femoral head can be accomplished by operative or non-operative methods.
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Eric C. Riddle, PA-S
Alfred I. duPont Hospital for Children
Department of Orthopaedics
Wilmington, DE 19899
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Richard Bowen, MD
Alfred I. duPont Hospital for Children
Wilmington, DE 19803-3607
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