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Legg-Calvé-Perthes Disease: Diagnosis, Decision Making, and Outcome
Tammy Ng1, Ruikang Liu2, Vedant A Kulkarni3
1Department of Pediatrics, UC Davis Health, Sacramento, CA.
Insights
Legg-Calvé-Perthes disease (LCPD) in children can cause femoral head deformity. Treatment aims to minimize this deformity and reduce the risk of future osteoarthritis.
Area of Science:
- Pediatric Orthopedics
- Pediatric Radiology
- Pediatric Rheumatology
Background:
- Legg-Calvé-Perthes disease (LCPD) is idiopathic avascular necrosis of the proximal capital femoral epiphysis in children.
- LCPD presentation varies, potentially leading to significant femoral head deformity and long-term functional deficits.
- The disease progresses through stages of ischemia, revascularization, and reossification, with mechanical weakening during healing increasing deformity risk.
Purpose of the Study:
- To highlight the diagnostic importance of plain radiography in LCPD.
- To emphasize treatment goals focused on minimizing femoral head deformity.
- To discuss potential future advancements in LCPD management.
Main Methods:
- Diagnosis relies on plain radiographic imaging.
- Treatment strategies include both operative and nonoperative approaches.
- The study reviews the characterized evolution of LCPD.
Main Results:
- Plain radiography is crucial for LCPD diagnosis and treatment guidance.
- Minimizing deformity is the primary treatment objective to prevent premature osteoarthritis.
- The etiology of LCPD remains unknown.
Conclusions:
- Effective management of LCPD involves strategies to mitigate femoral head deformity.
- Advanced imaging like perfusion MRI may improve surgical decisions.
- Emerging biological treatments show promise for enhancing femoral head healing.
Abstract:
Legg-Calvé-Perthes disease (LCPD), or idiopathic avascular necrosis of the proximal capital femoral epiphysis in children, has a variable presentation and can result in significant femoral head deformity that can lead to long-term functional deficits. Plain radiographic imaging is crucial in diagnosing LCPD and guiding treatment. Although the etiology of LCPD remains unknown, the evolution of the disease has been well characterized to include the phases of ischemia, revascularization, and reossification. The mechanical weakening during these phases of healing place the femoral head at high risk of deformity. Treatment of LCPD, therefore, focuses on minimizing deformity through operative and nonoperative strategies to reduce the risk of premature osteoarthritis. Advanced imaging using perfusion MRI may refine surgical decision making in the future, and biological treatments to improve femoral head healing are on the horizon.
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