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
• 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
  • Surgical
    • Generally only for children > 8 years
      • Younger children generally don’t benefit from surgery
    • Surgical containment by femoral or pelvic osteotomy
• Complications
  • The younger the patient, the better prognosis
  • Heals in 3 – 5 years
  • May lead to late osteoarthritis (Perthes is a prearthritic condition)