Legg-Calvé-Perthes disease is idiopathic avascular necrosis of the femoral head due to disruption of blood flow. It typically occurs in children aged 4 to 10 years and is more common in males. Patients typically present with hip pain and a limp, which is exacerbated by activity. Legg-Calvé-Perthes may be diagnosed on radiographs. X-rays may show widening of the cartilage space or a subchondral stress fracture. If left untreated, this will progress to femoral head deformity and subluxation from the acetabulum.
Management and Disposition
It is crucial patients have adequate orthopedic follow-up scheduled. Treatment depends on the phase of the disease. Patients with deformity of the femoral head will typically need surgery to prevent progression of malalignment of the hip joint.
Radiographs may still be normal early during the disease. Bone scan or MRI should be considered.
Legg-Calvé-Perthes disease is an idiopathic condition, so it is important to rule out other potential causes of avascular necrosis including leukemia, sickle cell disease, or corticosteroids.
Legg-Calvé-Perthes. Radiograph showing deformity of the right femoral head. (Reproduced with permission from Doherty GM. Current Diagnosis & Treatment: Surgery. 14th ed. New York, NY: McGraw Hill; 2015.)