eMedicine Specialties > Orthopedic Surgery > Hip

Legg-Calve-Perthes Disease: Treatment

Author: George D Harris, MD, MS, Professor of Medicine, University of Missouri-Kansas City School of Medicine and Truman Medical Center at Lakewood
Contributor Information and Disclosures

Updated: Jan 27, 2009

Treatment

Medical Therapy

Consultation with an orthopedist is recommended.

Treatment goals include eliminating hip irritability, restoring and maintaining good range of motion in the hip, preventing femoral epiphyseal collapse, and attaining a spherical femoral head when the hip heals.

Initial therapy includes minimal weight bearing and protection of the joint, which is accomplished by maintaining the femur abducted and internally rotated so that the femoral head is held well inside the rounded portion of the acetabulum. Abduction and rotation of the femur is accomplished either by the use of orthotic devices (bracing) or surgery (osteotomy). The Scottish Rite brace achieves containment by abduction while allowing free knee motion.

Surgical Therapy

Results of surgical containment appear to be better than those of nonsurgical containment (orthosis). Surgical approaches include either femoral osteotomy to redirect the involved portion within the acetabulum or innominate osteotomy. Both procedures produce equal results, but femoral osteotomy may cause shortening of the limb, leading to a chronic limp.3,4,5,6,7,8,9

Surgery does not speed healing of the femoral head, but it does cause the head to reossify in a more spherical fashion.

In a Norwegian study of Perthes' disease (Legg-Calve-Perthes' disease), Wiig et al followed 358 patients for 5 years and determined that proximal femoral varus osteotomy provided the best results in children 6 years and older with hips having more than 50% femoral head necrosis at the time of diagnosis. They found no significant difference between physiotherapy and abduction orthosis and therefore suggested abandoning abduction orthosis for Perthes' disease. For children younger than 6 years, no difference in outcome was determined for any of the 3 treatments.3

Follow-up

For excellent patient education resources, visit eMedicine's Foot, Ankle, Knee, and Hip Center and Sports Injury Center. Also, see eMedicine's patient education article Repetitive Motion Injuries.

Complications

Because Legg-Calv é -Perthes disease is a local self-healing disorder, treatment consists of protection of the joint by allowing new bone formation to occur and regain a spherical femoral head. The goal is to prevent (1) irregular contouring, flattening, or mushrooming of the head; (2) shortening and broadening of the neck; and (3) flattening of the vertical wall of the acetabulum. The development of any of these conditions can result in osteoarthritis at an early age.

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

  1. Poul J. Diagnosis of Legg-Calvé-Perthes disease. Ortop Traumatol Rehabil. Oct 30 2004;6(5):604-6. [Medline].

  2. 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].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. 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].

  8. 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].

  9. 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].

  10. Barkin RM, Rosen P. Emergency Pediatrics, A Guide to Ambulatory Care. 5th ed. St Louis: Mosby-Year Book;1999: 216, 278, 546-7.

  11. Hay WW, Hayward AR, Levin MJ. Current Pediatric Diagnosis and Treatment. 14th ed. Stamford; Appleton and Lange;1999: 710-1.

  12. 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.

  13. McMillan JA, DeAngelis CD, Feigin RD. Oski's Pediatrics Principles and Practice. 3rd ed. Philadelphia: Lippincott-Raven;1999: 2105-6.

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Further Reading

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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

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Contributor Information and Disclosures

Author

George D Harris, MD, MS, Professor of Medicine, University of Missouri-Kansas City School of Medicine and Truman Medical Center at Lakewood
George D Harris, MD, MS is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Medical Editor

B Sonny Bal, MD, Associate Professor, Department of Orthopedic Surgery, University of Missouri School of Medicine
B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James J McCarthy, MD, FAAOS, FAAP, Associate Professor, Consulting Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health;
James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Orthopaedic Association, Limb Lengthening and Reconstruction Society ASAMI-North America, Orthopaedics Overseas, Pediatric Orthopaedic Society of North America, Pennsylvania Medical Society, Pennsylvania Orthopaedic Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

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