eMedicine Specialties > Radiology > Pediatrics

Legg-Calve-Perthes Disease: Follow-up

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Coauthor(s): Dare Mutiyu Seriki, MBBS, FRCR, MRCP, Staff Physician, Department of Radiology, Hope Hospital, UK; Charles Edward Hutchinson, MD, FRCR, Senior Lecturer, Department of Diagnostic Radiology, University of Manchester; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Contributor Information and Disclosures

Updated: May 28, 2008

Intervention

No radiologic intervention is possible. Primarily, treatment includes medical bedrest, analgesia, bracing, or surgery. However, some benefit may be derived by draining the hip effusion of toxic synovitis, although this benefit is not proven. Effusion caused by septic arthritis can be diagnosed with sonography; after diagnosis, aspiration and treatment should follow promptly.2,10

Determining the prognosis is important at the time of presentation because more than 50% of patients with LPD do not require treatment. The earlier the stage of the disease at presentation, the better the prognosis. In the long term, approximately 50% of patients do not need treatment. Although osteoarthritis develops in some patients, most are able to function relatively well until their fifth or sixth decade of life.23

 


More on Legg-Calve-Perthes Disease

Overview: Legg-Calve-Perthes Disease
Imaging: Legg-Calve-Perthes Disease
Follow-up: Legg-Calve-Perthes Disease
Multimedia: Legg-Calve-Perthes Disease
References
[ CLOSE WINDOW ]

References

  1. Resnick D. Osteochondroses. In: Bralow L, ed. Bone and Joint Imaging. 2nd ed. Philadelphia: WB Saunders Co;1996: 960-6.

  2. Wheeless CR. Legg Calve Perthes Disease. In: Wheeless' Textbook of Orthopaedics [online]. Available at: http://www.medmedia.com/orthoo/242.htm. Accessed April 18, 2002. [Full Text].

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

  4. 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].

  5. Sharma S, Shewale S, Sibinski M, Sherlock DA. Legg-Calvé-Perthes disease affecting children less than eight years of age: a paired outcome study. Int Orthop. Jan 9 2008;[Medline].

  6. Van Campenhout A, Moens P, Fabry G. Serial bone scintigraphy in Legg-Calvé-Perthes disease: correlation with the Catterall and Herring classification. J Pediatr Orthop B. Jan 2006;15(1):6-10. [Medline].

  7. Meadows C, Monsell F, Ramanan AV. Normal x rays in Perthes disease. Arch Dis Child. Mar 2008;93(3):211. [Medline].

  8. Nelson D, Zenios M, Ward K, Ramachandran M, Little DG. The deformity index as a predictor of final radiological outcome in Perthes' disease. J Bone Joint Surg Br. Oct 2007;89(10):1369-74. [Medline].

  9. Wingstrand H. Significance of synovitis in Legg-Calve-Perthes disease. J Pediatr Orthop B. Jul 1999;8(3):156-60. [Medline].

  10. Zawin JK, Hoffer FA, Rand FF, Teele RL. Joint effusion in children with an irritable hip: US diagnosis and aspiration. Radiology. May 1993;187(2):459-63. [Medline].

  11. Eckerwall G, Hochbergs P, Wingstrand H, Egund N. Sonography and intracapsular pressure in Perthes'' disease. 39 children examined 2-36 months after onset. Acta Orthop Scand. Dec 1994;65(6):575-80. [Medline].

  12. Eggl H, Drekonja T, Kaiser B, Dorn U. Ultrasonography in the diagnosis of transient synovitis of the hip and Legg-Calve-Perthes disease. J Pediatr Orthop B. Jul 1999;8(3):177-80. [Medline].

  13. Naumann T, Kollmannsberger A, Fischer M, et al. Ultrasonographic evaluation of Legg-Calve-Perthes disease based on sonoanatomic criteria and the application of new measuring techniques. Eur J Radiol. Sep 1992;15(2):101-6. [Medline].

  14. Wirth T, LeQuesne GW, Paterson DC. Ultrasonography in Legg-Calve-Perthes disease. Pediatr Radiol. 1992;22(7):498-504. [Medline].

  15. Jaramillo D, Galen TA, Winalski CS. Legg-Calve-Perthes disease: MR imaging evaluation during manual positioning of the hip--comparison with conventional arthrography. Radiology. Aug 1999;212(2):519-25. [Medline].

  16. Sebag G, Ducou Le Pointe H, Klein I. Dynamic gadolinium-enhanced subtraction MR imaging--a simple technique for the early diagnosis of Legg-Calve-Perthes disease: preliminary results. Pediatr Radiol. Mar 1997;27(3):216-20. [Medline].

  17. Hosokawa M, Kim WC, Kubo T, et al. Preliminary report on usefulness of magnetic resonance imaging for outcome prediction in early-stage Legg-Calve-Perthes disease. J Pediatr Orthop B. Jul 1999;8(3):161-4. [Medline].

  18. Song HR, Dhar S, Na JB, et al. Classification of metaphyseal change with magnetic resonance imaging in Legg-Calve-Perthes disease. J Pediatr Orthop. Sep-Oct 2000;20(5):557-61. [Medline].

  19. de Sanctis N, Rega AN, Rondinella F. Prognostic evaluation of Legg-Calve-Perthes disease by MRI. Part I: the role of physeal involvement. J Pediatr Orthop. Jul-Aug 2000;20(4):455-62. [Medline].

  20. de Sanctis N, Rondinella F. Prognostic evaluation of Legg-Calve-Perthes disease by MRI. Part II: pathomorphogenesis and new classification. J Pediatr Orthop. Jul-Aug 2000;20(4):463-70. [Medline].

  21. Doria AS, Cunha FG, Modena M, Maciel R, Molnar LJ, Luzo C, et al. Legg-Calvé-Perthes disease: multipositional power Doppler sonography of the proximal femoral vascularity. Pediatr Radiol. Apr 2008;38(4):392-402. [Medline].

  22. Stücker MH, Buthmann J, Meiss AL. Evaluation of hip containment in legg-calvé-perthes disease: a comparison of ultrasound and magnetic resonance imaging. Ultraschall Med. Oct 2005;26(5):406-10. [Medline].

  23. Sinigaglia R, Bundy A, Okoro T, Gigante C, Turra S. Is conservative treatment really effective for Legg-Calvé-Perthes disease? A critical review of the literature. Chir Narzadow Ruchu Ortop Pol. Nov-Dec 2007;72(6):439-43. [Medline].

  24. Glueck CJ, Tracy T, Wang P. Legg-Calve-Perthes disease, venous and arterial thrombi, and the factor V Leiden mutation in a four-generation kindred. J Pediatr Orthop. Oct-Nov 2007;27(7):834-7. [Medline].

  25. Hubbard AM, Dormans JP. Evaluation of developmental dysplasia, Perthes disease, and neuromuscular dysplasia of the hip in children before and after surgery: an imaging update. AJR Am J Roentgenol. May 1995;164(5):1067-73. [Medline].

  26. Jaramillo D, Kasser JR, Villegas-Medina OL. Cartilaginous abnormalities and growth disturbances in Legg-Calve- Perthes disease: evaluation with MR imaging. Radiology. Dec 1995;197(3):767-73. [Medline].

  27. Joo SY, Lee KS, Koh IH, Park HW, Kim HW. Trochanteric advancement in patients with Legg-Calvé-Perthes disease does not improve pain or limp. Clin Orthop Relat Res. Apr 2008;466(4):927-34. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Legg-Calvé-Perthes, Legg-Perthes disease, Perthes disease, idiopathic avascular necrosis of the proximal femoral epiphysis, pediatric hip disorder, childhood hip disorder, epiphyseal bone infarction, femoral head infarction, Chandler disease, LPD, LCP

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Dare Mutiyu Seriki, MBBS, FRCR, MRCP, Staff Physician, Department of Radiology, Hope Hospital, UK
Disclosure: Nothing to disclose.

Charles Edward Hutchinson, MD, FRCR, Senior Lecturer, Department of Diagnostic Radiology, University of Manchester
Charles Edward Hutchinson, MD, FRCR is a member of the following medical societies: British Institute of Radiology
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Fredric A Hoffer, MD, FAAP, FSIR, Professor of Radiology, University of Washington; Section Chief of Interventional Radiology, Department of Radiology, Seattle Children's Hospital and Regional Medical Center
Fredric A Hoffer, MD, FAAP, FSIR is a member of the following medical societies: American Academy of Pediatrics, Children's Oncology Group, Radiological Society of North America, Society for Pediatric Radiology, and Society of Interventional Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Marta Hernanz-Schulman, MD, FAAP, Professor, Radiology, Radiological Sciences, and Pediatrics, Director, Department of Pediatric Radiology, Radiologist-in-Chief, Director, Department of Diagnostic Imaging, Vanderbilt University Medical Center, Vanderbilt Children's Hospital
Marta Hernanz-Schulman, MD, FAAP is a member of the following medical societies: American Institute of Ultrasound in Medicine and American Roentgen Ray Society
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.