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Management of Legg-Calve-Perthes disease: a scoping review with advice on initial management
Rebecca Beni1, Sabba A Hussain2,3, Fergal Monsell4
1City St. George's University of London, London, UK.
Insights
Legg-Calve-Perthes disease (LCPD) is a childhood hip disorder causing avascular necrosis. Early primary care detection and management are vital for preventing long-term disability and osteoarthritis.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
Background:
- Legg-Calve-Perthes disease (LCPD) is a pediatric hip disorder characterized by avascular necrosis of the femoral head.
- It can lead to significant long-term musculoskeletal complications extending into adulthood.
- Early diagnosis and intervention in primary care settings are critical but often challenging.
Purpose of the Study:
- To offer primary healthcare professionals a concise review of LCPD.
- To provide practical guidance on presentation, differential diagnosis, and management.
- To emphasize the role of primary care in early detection and referral.
Main Methods:
- A review of recent scientific literature and expert consensus.
- Summarization of LCPD epidemiology, diagnostic methods, and current treatment strategies.
Main Results:
- LCPD typically presents as a painless limp in children aged 2-14 years.
- Diagnosis relies on clinical presentation and radiographic findings.
- Management is individualized, ranging from conservative (physiotherapy) to surgical interventions aimed at preserving joint function and delaying osteoarthritis.
Conclusions:
- Early recognition of LCPD in primary care is essential for prompt referral to orthopedic specialists.
- Comprehensive management includes non-surgical and surgical options, alongside crucial interim support.
- Addressing the physical, mental, and social developmental impacts of LCPD is vital for affected children.
Background:
Legg-Calve-Perthes disease (LCPD) is a developmental disorder causing avascular necrosis of the femoral head in children, with long-term consequences that can extend into adulthood. Early diagnosis and management in primary care are crucial but challenging.
Aim:
This review aims to provide a concise overview of the presentation, differential diagnosis and management of LCPD, offering practical guidance for primary healthcare professionals.
Method:
Recent literature and expert opinions were reviewed to summarise the epidemiology, diagnosis and current management of LCPD.
Results:
LCPD commonly presents as a painless limp in children aged between 2 and 14 years, with the diagnosis based on the clinical features and radiographic abnormalities. Management is individualised and includes non-operative care to surgery, which attempts to correct anatomical abnormalities and therefore delay the onset of osteoarthritis. The review highlights the importance of primary care in early detection, appropriate referral and interim management.
Conclusion:
LCPD is a rare condition that can lead to long-term disability, affecting a child's physical, mental and social development, often presenting as a painless limp. Diagnosis typically involves plain radiographs, with MRI or hip joint arthrography providing additional details for management, which may include both non-surgical (eg, physiotherapy) and surgical options. Early recognition by primary care providers is crucial for timely referral to orthopaedic services, along with interim support through physiotherapy, pain management and access to mental health and educational resources.
