Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Legg-Calve-Perthes Disease Workup

  • Author: George D Harris, MD, MS; Chief Editor: William L Jaffe, MD  more...
 
Updated: Mar 04, 2015
 

Laboratory Studies

Recommended studies include a complete blood count (CBC) with differential and measurement of the erythrocyte sedimentation rate (ESR); however, findings may be normal.

Next

Imaging Studies

Obtain hip radiographs, including anteroposterior and frog-leg lateral views of the pelvis, to establish the diagnosis.[2, 3] (See the images below.)

Image from 8-year-old boy with Herring type C Legg Image from 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 radiograph from 9-year-old boy wit Anteroposterior radiograph from 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 Frog-leg lateral radiograph of same 9-year-old boy with Legg-Calvé-Perthes disease as in previous radiograph. Image courtesy of Dennis P Grogan, MD.

Initial radiographs can be normal, but radiographic changes can be divided into five distinct stages representing a continuum of the disease process, as follows:

  • Stage 1 - Cessation of femoral epiphyseal growth
  • Stage 2 - Subchondral fracture
  • Stage 3 - Resorption
  • Stage 4 - Reossification
  • Stage 5 - 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.

A bone scan can be used to evaluate the site for avascular necrosis.

Previous
 
 
Contributor Information and Disclosures
Author

George D Harris, MD, MS Professor and Chair, Department of Family Medicine, West Virginia University Eastern Division School of Medicine; Attending Physician, Jefferson Medical Center; Medical Director, University Healthcare Physicians Primary Care Division

George D Harris, MD, MS is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Association, American Medical Society for Sports Medicine, Society of Teachers of Family Medicine, American Society for Colposcopy and Cervical Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

James J McCarthy, MD, FAAOS, FAAP Director, Division of Orthopedic Surgery, Cincinnati Children's Hospital; Professor, Department of Orthopedic Surgery, University of Cincinnati College of Medicine

James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Orthopaedic Association, Pennsylvania Medical Society, Philadelphia County Medical Society, Pennsylvania Orthopaedic Society, Pediatric Orthopaedic Society of North America, Orthopaedics Overseas, Limb Lengthening and Reconstruction Society, Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Orthopediatrics, Phillips Healthcare, POSNA<br/>Serve(d) as a speaker or a member of a speakers bureau for: Synthes<br/>Received research grant from: University of Cincinnati<br/>Received royalty from Lippincott Williams and WIcins for editing textbook; Received none from POSNA for board membership; Received none from LLRS for board membership; Received consulting fee from Synthes for none.

Chief Editor

William L Jaffe, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases

William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American College of Surgeons, Eastern Orthopaedic Association, New York Academy of Medicine

Disclosure: Received consulting fee from Stryker Orthopaedics for speaking and teaching.

Additional Contributors

B Sonny Bal, MD, JD, MBA Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

B Sonny Bal, MD, JD, MBA is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Received none from Bonesmart.org for online orthopaedic marketing and information portal; Received none from OrthoMind for social networking for orthopaedic surgeons; Received stock options and compensation from Amedica Corporation for manufacturer of orthopaedic implants; Received ownership interest from BalBrenner LLC for employment; Received none from ConforMIS for consulting; Received none from Microport for consulting.

References
  1. Hailer YD, Montgomery S, Ekbom A, Nilsson O, Bahmanyar S. Legg-Calvé-Perthes disease and the risk of injuries requiring hospitalization: a register study involving 2579 patients. Acta Orthop. 2012 Dec. 83(6):572-6. [Medline]. [Full Text].

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

  3. Sales de Gauzy J, Briot J, Swider P. Coxa magna quantification using MRI in Legg-Calve-Perthes disease. Clin Biomech (Bristol, Avon). 2009 Jan. 24(1):43-6. [Medline].

  4. 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. 2008 Oct. 90(10):1364-71. [Medline].

  5. 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. 2008 Dec. 28(8):819-24. [Medline].

  6. Canavese F, Dimeglio A. Perthes' disease: prognosis in children under six years of age. J Bone Joint Surg Br. 2008 Jul. 90(7):940-5. [Medline].

  7. 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. 2008 Mar. 28(2):169-72. [Medline].

  8. 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. 2007 Dec. 89(12):2712-22. [Medline].

  9. Zarzycka M, Zarzycki D, Kacki W, Jasiewicz B, Ridan T. Long-term results of conservative treatment in Perthes' disease. Ortop Traumatol Rehabil. 2004 Oct 30. 6(5):595-603. [Medline].

  10. 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].

  11. Kim HK, da Cunha AM, Browne R, Kim HT, Herring JA. How much varus is optimal with proximal femoral osteotomy to preserve the femoral head in legg-calve-perthes disease?. J Bone Joint Surg Am. 2011 Feb. 93(4):341-7. [Medline].

  12. Karimi MT, McGarry T. A comparison of the effectiveness of surgical and nonsurgical treatment of legg-calve-perthes disease: a review of the literature. Adv Orthop. 2012. 2012:490806. [Medline].

  13. Pailhé R, Cavaignac E, Murgier J, Cahuzac JP, de Gauzy JS, Accadbled F. Triple osteotomy of the pelvis for Legg-Calve-Perthes disease: a mean fifteen year follow-up. Int Orthop. 2015 Feb 3. [Medline].

  14. Heesakkers N, van Kempen R, Feith R, Hendriks J, Schreurs W. The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty one years. Int Orthop. 2014 Nov 19. [Medline].

  15. Traina F, De Fine M, Sudanese A, Calderoni PP, Tassinari E, Toni A. Long-term results of total hip replacement in patients with legg-calve-perthes disease. J Bone Joint Surg Am. 2011 Apr. 93(7):e25. [Medline].

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

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

  18. Lauren M. Simon. Chapter 35. Thigh, Hip, and Pelvis Injuries. Richard B. Birrer. Pediatric Sports Medicine for Primary Care. philadelphia, PA.: Lippincott Williams and Wilkins; 2002. pages 393-394.

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

 
Previous
Next
 
Image from 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 radiograph from 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 previous radiograph. Image courtesy of Dennis P Grogan, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.