eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Legg-Calve-Perthes Disease

Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Contributor Information and Disclosures

Updated: Dec 1, 2009

Introduction

Background

Legg-Calvé-Perthes disease (LCPD) is the name given to idiopathic osteonecrosis of the capital femoral epiphysis of the femoral head. The goal of treatment is to avoid severe degenerative arthritis.

Pathophysiology

The capital femoral epiphysis always is involved. In 15-20% of patients with Legg-Calve-Perthes disease, involvement is bilateral.

Frequency

United States

One in 1200 children younger than 15 years is affected by Legg-Calve-Perthes disease.

Mortality/Morbidity

  • Legg-Calve-Perthes disease is a self-limited disease if not treated.
  • Outcome is extremely variable.

Race

Caucasians are affected more frequently than persons of other races.

Sex

Males are affected 4-5 times more often than females.

Age

LCPD most commonly is seen in persons aged 3-12 years, with a median age of 7 years.

Clinical

History

Symptoms of Legg-Calv é -Perthes disease usually have been present for weeks because the child often does not complain.

  • Hip or groin pain, which may be referred to the thigh
  • Mild or intermittent pain in anterior thigh or knee
  • Limp
  • Usually no history of trauma

Physical

  • Decreased range of motion (ROM), particularly with internal rotation and abduction
  • Painful gait
  • Atrophy of thigh muscles secondary to disuse
  • Muscle spasm
  • Leg length inequality due to collapse
  • Thigh atrophy: Thigh circumference on the involved side will be smaller than on the unaffected side secondary to disuse.
  • Short stature: Children with LCPD often have delayed bone age.
  • Roll test
    • With patient lying in the supine position, the examiner rolls the hip of the affected extremity into external and internal rotation.
    • This test should invoke guarding or spasm, especially with internal rotation.

Causes

The etiology of Legg-Calv é -Perthes disease remains unclear; however, the following scenario generally is accepted:

  • The blood supply to the capital femoral epiphysis is interrupted.
  • Bone infarction occurs, especially in the subchondral cortical bone, while articular cartilage continues to grow. (Articular cartilage grows because its nutrients come from the synovial fluid.)
  • Revascularization occurs, and new bone ossification starts.
  • At this point, a percentage of patients develop LCPD, while other patients have normal bone growth and development.
  • LCPD is present when a subchondral fracture occurs. This is usually the result of normal physical activity, not direct trauma to the area
  • Changes to the epiphyseal growth plate occur secondary to the subchondral fracture.

More on Legg-Calve-Perthes Disease

Overview: Legg-Calve-Perthes Disease
Differential Diagnoses & Workup: Legg-Calve-Perthes Disease
Treatment & Medication: Legg-Calve-Perthes Disease
Follow-up: Legg-Calve-Perthes Disease
Multimedia: Legg-Calve-Perthes Disease
References
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References

  1. 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. Feb 2009;33(1):231-5. [Medline].

  2. 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].

  3. Boss JH, Misselevich I. Osteonecrosis of the femoral head of laboratory animals: the lessons learned from a comparative study of osteonecrosis in man and experimental animals. Vet Pathol. Jul 2003;40(4):345-54. [Medline].

  4. Epidemiology of Perthes' disease. Arch Dis Child. May 2000;82(5):385. [Medline].

  5. Erkula G, Bursal A, Okan E. False profile radiography for the evaluation of Legg-Calve-Perthes disease. J Pediatr Orthop B. Jul 2004;13(4):238-43. [Medline].

  6. Frick SL. Evaluation of the child who has hip pain. Orthop Clin North Am. Apr 2006;37(2):133-40, v. [Medline].

  7. Herring JA. The treatment of Legg-Calve-Perthes disease. A critical review of the literature. J Bone Joint Surg Am. Mar 1994;76(3):448-58. [Medline].

  8. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. Oct 2004;86-A(10):2103-20. [Medline].

  9. Jacobs R, Moens P, Fabry G. Lateral shelf acetabuloplasty in the early stage of Legg-Calve-Perthes disease with special emphasis on the remaining growth of the acetabulum: a preliminary report. J Pediatr Orthop B. Jan 2004;13(1):21-8. [Medline].

  10. Kamegaya M, Saisu T, Ochiai N, Hisamitsu J, Moriya H. A paired study of Perthes' disease comparing conservative and surgical treatment. J Bone Joint Surg Br. Nov 2004;86(8):1176-81. [Medline].

  11. Kaniklides C. Diagnostic radiology in Legg-Calve-Perthes disease. Acta Radiol Suppl. 1996;406:1-28. [Medline].

  12. Kaniklides C, Lonnerholm T, Moberg A. Legg-Calve-Perthes disease. Comparison of conventional radiography, MR imaging, bone scintigraphy and arthrography. Acta Radiol. Jul 1995;36(4):434-9. [Medline].

  13. Molloy MK, MacMahon B. Incidence of Legg-Perthes disease (osteochondritis deformans). N Engl J Med. Nov 3 1966;275(18):988-90. [Medline].

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

  15. Roy DR. Current concepts in Legg-Calve-Perthes disease. Pediatr Ann. Dec 1999;28(12):748-52. [Medline].

  16. 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].

  17. Skaggs DL, Tolo VT. Legg-Calve-Perthes Disease. J Am Acad Orthop Surg. Jan 1996;4(1):9-16. [Medline].

  18. Thompson GH, Salter RB. Legg-Calve-Perthes disease. Clin Symp. 1986;38(1):2-31. [Medline].

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Further Reading

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Keywords

Legg-Calvé-Perthes disease, Perthes disease, Legg-Calve-Perthes disease symptoms, Legg-Calve-Perthes disease treatment, hip joint disease, Legg disease, Legg's disease, Legg-Perthes disease, Calvé-Perthes disease, coxa plana, osteochondritis deformans juvenilis, osteonecrosis, capital femoral epiphysis, degenerative arthritis

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Contributor Information and Disclosures

Author

Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Eric M Kardon, MD, FACEP, Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center
Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

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