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Published on: May 25, 2012
Legg-Calvé-Perthes Disease
Shawn R Gilbert1, Jennifer C Laine, Benjamin D Martin
1From the Children's of Alabama, UAB Department of Orthopaedic Surgery, Birmingham, AL (Gilbert), Pediatric Orthopaedic Surgeon, Gillette Children's Specialty Healthcare, University of Minnesota Department of Orthopaedic Surgery, St. Paul, MN (Laine), Division of Orthopaedic Surgery & Sports Medicine, Children's National Washington, DC (Martin), Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Sankar), and Center of Excellence in Hip, Scottish Rite for Children, University of Texas Southwestern Medical Center, International Perthes Study Group, Dallas, TX (Kim).
Insights
Legg-Calvé-Perthes disease is childhood hip osteonecrosis. Treatment aims to preserve hip function by maintaining femoral head containment and range of motion.
Area of Science:
- Pediatric Orthopedics
- Pediatric Bone Diseases
Background:
- Legg-Calvé-Perthes disease is a childhood hip condition involving femoral head osteonecrosis.
- It follows a predictable course: bone death, revascularization, resorption, and reossification.
- Outcomes vary with age at diagnosis, with younger children generally having better prognoses.
Purpose of the Study:
- To review the pathophysiology, natural history, and treatment strategies for Legg-Calvé-Perthes disease.
- To highlight challenges in demonstrating treatment superiority and areas of current research focus.
Main Methods:
- Literature review of Legg-Calvé-Perthes disease.
- Analysis of natural history, diagnostic factors, and treatment outcomes.
- Discussion of current research trends in imaging and pathophysiology.
Main Results:
- The final outcome depends on the healed femoral head's shape and acetabular congruence.
- Treatment aims to maintain femoral head containment and joint range of motion.
- Treatment strategies include non-surgical (restricted weight-bearing, exercises, bracing) and surgical (osteotomies, joint distraction) options.
Conclusions:
- Demonstrating the superiority of specific treatments is challenging due to the condition's rarity and variable course.
- Current research focuses on improved imaging predictors and understanding disease pathophysiology.
- Effective management requires preserving hip function and minimizing mechanical damage to the femoral head.
Abstract:
Legg-Calvé-Perthes disease has been recognized for more than 100 years. It is an idiopathic osteonecrosis of the femoral head in children that follows a predictable course of bone death, revascularization, bone resorption, and eventually reossification and bone healing. The natural history is often favorable for children younger than 6 years and poor for children older than 8 to 10 years. The final outcome is determined by the shape of the healed femoral head and its congruence with the acetabulum. Treatment is aimed at preserving range of motion, maintaining containment, and limiting mechanical damage to the femoral head. Nonsurgical interventions include restricted weight-bearing, range of motion exercises, and casting or bracing treatment. Surgical interventions include osteotomies of the femur or pelvis or both to maintain containment, as well as joint distraction for containment and decreasing mechanical force. Superiority of a particular treatment strategy has been difficult to demonstrate due to relative rarity of the condition, variable natural history, and long-time horizon to predict final outcome. Recent research has focused on better imaging predictors and understanding and altering the pathophysiology subsequent to the vascular disturbance.
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