Recurrent Legg-Perthes-Calvé disease

Area of Science:

• Pediatric Orthopedics
• Pediatric Rheumatology
• Paediatric Osteology

Background:

• Legg-Perthes-Calvé disease (LPC), a common hip osteochondritis, is generally considered a non-recurrent condition.
• This study investigates an exceptional case of recurrent LPC in a pediatric patient.
• The established understanding of LPC suggests a single episode confers lifelong immunity, a concept challenged by this case.

Observation:

• A 4.5-year-old girl was diagnosed with bilateral LPC and treated with a Scottish-Rite (Atlanta) brace.
• Initial treatment led to complete healing of the right hip (Catterall group 2) within 1.5 years.
• At age 8, the patient presented with a limp and functional disorder due to a recurrence of right-hip LPC (Catterall group 3).

Findings:

• A literature review identified 10 previous cases of recurrent LPC, totaling 11 children (2 girls, 9 boys).
• Recurrent LPC occurred at a mean age of 9.4 years (range, 6-12 years) and was often more severe than the initial episode.
• Despite recurrence, the final clinical and radiological outcomes at bone maturity were satisfactory.

Implications:

• The findings challenge the "vaccination" theory, suggesting that initial LPC does not guarantee immunity.
• This case supports the diagnosis of true LPC recurrence rather than alternative conditions like Meyer's disease.
• Further research into recurrent LPC is warranted to refine understanding and management strategies for this rare condition.