eMedicine Specialties > Orthopedic Surgery > Hip
Legg-Calve-Perthes Disease: Workup
Updated: Jan 27, 2009
Workup
Laboratory Studies
- Determination of the CBC with a differential and the erythrocyte sedimentation rate (ESR) are recommended, but the findings may be normal.
Imaging Studies
Image in an 8-year-old boy with Herring type C Legg-Calvé-Perthes disease shows evidence of lateral extrusion. Symptoms began 18 months before this view was obtained. Image courtesy of Dennis P. Grogan, MD.
Anteroposterior (AP) radiograph in a 9-year-old boy with Legg-Calvé-Perthes disease. Image courtesy of Dennis P. Grogan, MD.
Frog-leg lateral radiograph of same 9-year-old boy with Legg-Calvé-Perthes disease as in Image above. Image courtesy of Dennis P. Grogan, MD.
- Obtain hip radiographs, including anteroposterior and frog-leg lateral views of the pelvis to establish the diagnosis.1,2
- Initial radiographs can be normal, but radiographic changes can be divided into 5 distinct stages representing a continuum of the disease process.
- Stage 1 reveals cessation of femoral epiphyseal growth.
- Stage 2 is a subchondral fracture.
- Stage 3 shows resorption.
- Stage 4 demonstrates reossification.
- Stage 5 is the healed or residual stage.
- Early radiographic changes may reveal only a nonspecific effusion of the joint associated with slight widening of the joint space, metaphyseal demineralization (decreased bone density around the joint), and periarticular swelling (bulging capsule). This is the acute phase, and it may last 1-2 weeks. Decreasing bone density in and around the joint is noted after a few weeks.
- With advancement of the disease, the joint space between the ossified head and acetabulum widens as the necrotic ossification center appears denser than the surrounding structures. Narrowing or collapse of the femoral head causes it to appear widened and flattened (coxa plana). A varus deformity of the femoral neck may occur as a result of damage to the femoral head growth center and overgrowth of the greater trochanteric apophysis.
- Eventually, the disease may progress to collapse of the femoral head, increase in the width of the neck, and demineralization of the femoral head. The final shape of this area depends on the extent of necrosis and the degree of collapse. All of the findings are correlated with disease progression and the extent of necrosis. This is the active phase, and it can last 12-40 months.
- Initial radiographs can be normal, but radiographic changes can be divided into 5 distinct stages representing a continuum of the disease process.
- A bone scan can be used to evaluate the site for avascular necrosis.
More on Legg-Calve-Perthes Disease |
| Overview: Legg-Calve-Perthes Disease |
 Workup: Legg-Calve-Perthes Disease |
| Treatment: Legg-Calve-Perthes Disease |
| Follow-up: Legg-Calve-Perthes Disease |
| Multimedia: Legg-Calve-Perthes Disease |
| References |
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References
Poul J. Diagnosis of Legg-Calvé-Perthes disease. Ortop Traumatol Rehabil. Oct 30 2004;6(5):604-6. [Medline].
Sales de Gauzy J, Briot J, Swider P. Coxa magna quantification using MRI in Legg-Calve-Perthes disease. Clin Biomech (Bristol, Avon). Jan 2009;24(1):43-6. [Medline].
Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br. Oct 2008;90(10):1364-71. [Medline].
Beer Y, Smorgick Y, Oron A, Mirovsky Y, Weigl D, Agar G, et al. Long-term results of proximal femoral osteotomy in Legg-Calvé-Perthes disease. J Pediatr Orthop. Dec 2008;28(8):819-24. [Medline].
Canavese F, Dimeglio A. Perthes' disease: prognosis in children under six years of age. J Bone Joint Surg Br. Jul 2008;90(7):940-5. [Medline].
Myers GJ, Mathur K, O'Hara J. Valgus osteotomy: a solution for late presentation of hinge abduction in Legg-Calvé-Perthes disease. J Pediatr Orthop. Mar 2008;28(2):169-72. [Medline].
Rosenfeld SB, Herring JA, Chao JC. Legg-calve-perthes disease: a review of cases with onset before six years of age. J Bone Joint Surg Am. Dec 2007;89(12):2712-22. [Medline].
Zarzycka M, Zarzycki D, Kacki W, Jasiewicz B, Ridan T. Long-term results of conservative treatment in Perthes' disease. Ortop Traumatol Rehabil. Oct 30 2004;6(5):595-603. [Medline].
Nowacki W, Szymkowiak E, Futyma J, Stencel P. A comparative analysis of conservative and surgical treatment of Perthes' disease. Ortop Traumatol Rehabil. 2004;6(6):748-50. [Medline].
Barkin RM, Rosen P. Emergency Pediatrics, A Guide to Ambulatory Care. 5th ed. St Louis: Mosby-Year Book;1999: 216, 278, 546-7.
Hay WW, Hayward AR, Levin MJ. Current Pediatric Diagnosis and Treatment. 14th ed. Stamford; Appleton and Lange;1999: 710-1.
Lauren M. Simon. Chapter 35. Thigh, Hip, and Pelvis Injuries. In: Richard B. Birrer. Pediatric Sports Medicine for Primary Care. philadelphia, PA.: Lippincott Williams and Wilkins; 2002:pages 393-394.
McMillan JA, DeAngelis CD, Feigin RD. Oski's Pediatrics Principles and Practice. 3rd ed. Philadelphia: Lippincott-Raven;1999: 2105-6.
Further Reading
Keywords
LCPD, osteochondrosis of the femoral head, avascular necrosis of the proximal femoral head, intermittent limp, abductor lurch, painless limp, persistent hip pain, Trendelenburg gait
