Legg-Calve-Perthes disease
- Legg-Calve-Perthes disease = Perthes disease = idiopathic avascular necrosis of the femoral head
- Epidemiology
- 3 – 16 years
- Boys > girls
- Etiology: Idiopathic by definition
- Pathomechanism
- The femoral epiphysis grows quickly and is therefore highly dependent on adequate blood supply
- Inadequate blood supply can be due to compression of the arteries (for example from transient coxitis)
- Clinical features
- Usually unilateral
- Antalgic gait
- Pain in groin, thigh, or knee
- Limited internal rotation and abduction
- Diagnosis
- X-ray
- Often shows nothing the first 3 – 6 months
- Shows flat, collapsed femoral head
- MRI
- If x-ray is negative but clinical suspicion persists
- X-ray
- Treatment
- The primary aim of treatment of Perthes disease is containment (= holding the femoral head in the acetabulum)
- Can be achieved by conservative therapies or by surgery
- Conservative
- Non-weightbearing activities
- To allow re-ossification
- Swimming is excellent
- Pain management
- Physical therapy
- Non-weightbearing activities
- Surgical
- Generally only for children > 8 years
- Younger children generally don’t benefit from surgery
- Surgical containment by femoral or pelvic osteotomy
- Generally only for children > 8 years
- The primary aim of treatment of Perthes disease is containment (= holding the femoral head in the acetabulum)
- Complications
- The younger the patient, the better prognosis
- Heals in 3 – 5 years
- May lead to late osteoarthritis (Perthes is a prearthritic condition)