Legg-Calve-Perthes Disease in Emergency Medicine
- Author: Jessica Hernandez, MD; Chief Editor: Trevor John Mills, MD, MPH more...
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. Legg-Calvé-Perthes disease can lead to hip deformities and severe degenerative arthritis.
The pathophysiology and temporal sequence of events in Legg-Calvé-Perthes disease remains unclear; however, the following scenario is generally accepted:
- The blood supply to the femoral head is interrupted.
- Bone infarction and necrosis affects the articular cartilage, subchondral bone, and the bony epiphysis.
- Revascularization occurs and new bone ossification starts. In some cases, patients may have normal bone growth and development.
- 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.
- This may result in deformities in the femoral head, epiphyseal growth plate, and possible lesions in the metaphysis.
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.
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.
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