Legg-Calve-Perthes Disease in Emergency Medicine

Updated: Sep 23, 2015
  • Author: Jessica Hernandez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
  • Print
Overview

Background

Legg-Calvé-Perthes disease is the eponym given to idiopathic osteonecrosis of the femoral head. It was described approximately 100 years ago as a unique disease entity affecting the pediatric population. [1] Legg-Calvé-Perthes disease can lead to hip deformities and severe degenerative arthritis.

Next:

Pathophysiology

The pathophysiology and temporal sequence of events in Legg-Calvé-Perthes disease remains unclear; however, the following scenario is generally accepted:

  1. The blood supply to the femoral head is interrupted. [2]
  2. Bone infarction and necrosis affects the articular cartilage, subchondral bone, and the bony epiphysis. [3]
  3. Revascularization occurs and new bone ossification starts. In some cases, patients may have normal bone growth and development.
  4. With progression of the disease, bone resorption, delayed bone formation, and subchondral fracture occurs. This microdamage is usually the result of normal physical activity, not direct trauma.
  5. This may result in deformities in the femoral head, epiphyseal growth plate, and possible lesions in the metaphysis. [3]
Previous
Next:

Epidemiology

One in 1200 children younger than 15 years is affected by Legg-Calvé-Perthes disease. Legg-Calvé-Perthes disease most commonly is seen in persons aged 3-12 years, with a median age of 7 years.The disease is familial approximately 10% of the time. [4]  

Legg-Calvé-Perthes disease is a self-limited disease if not treated. Outcome widely varies. In 15-20% of patients with Legg-Calvé-Perthes disease, involvement is bilateral.

Whites are affected more frequently than persons of other races. Males are affected 4-5 times more often than females.

In a study of girls with Legg-Calvé-Perthes disease, of the 451 patients who presented at a single large urban children's hospital from 1990-2014 with a diagnosis of Legg-Calvé-Perthes disease, 82 (18.2%) were female. The average age at presentation for girls was 6.58 years. [5]

 

Previous