Legg-Calvé-Perthes' disease

Last reviewed: 6 Nov 2022
Last updated: 03 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • limp
  • limited range of motion at the hip joint
More key diagnostic factors

Other diagnostic factors

  • short stature
  • muscle wasting
  • hyperactivity
  • Trendelenburg's sign
  • synovitis
  • knee pain
  • thigh pain
  • groin/buttock pain
  • asymmetric limb length
  • minor trauma
Other diagnostic factors

Risk factors

  • male sex
  • age 4 to 8 years
  • low socio-economic background
  • hyper-coagulable states
  • urban population
  • race and northern latitude
  • transient hip synovitis
  • hip joint effusion
  • passive smoking
  • skeletal dysplasias
  • congenital anomalies
  • trisomy 21
  • behaviour disorders
  • endocrinopathy
More risk factors

Diagnostic investigations

1st investigations to order

  • bilateral hip x-rays
More 1st investigations to order

Investigations to consider

  • FBC
  • serum erythrocyte sedimentation rate
  • serum C-reactive protein
  • bone scintigraphy
  • MRI of hips
More investigations to consider

Treatment algorithm

ACUTE

with acute pain

ONGOING

under 5 years

5 to 7 years

over 7 years to 12 years

over 12 years

Contributors

Authors

Andrew Wainwright, FRCS (Tr & Orth) Med

Consultant Orthopaedic Surgeon

Nuffield Orthopaedic Centre

Oxford

UK

Disclosures

AW declares that he has no competing interests.

Dominique Knight, BSc, MBBS, FRCS

Consultant Paediatric Orthopaedic Surgeon

Bristol Royal Children’s Hospital

Bristol

UK

Disclosures

DK declares that she has no competing interests.

Acknowledgements

Dr Andrew Wainwright and Dr Dominique Knight would like to acknowledge Dr Jwalant S. Mehta and Dr Sandeep Hemmadi, who wrote the original topic and whose work is largely reflected in the current version. JSM and SH declared that they had no competing interests.

Peer reviewers

Phillip Thomas, FRCS (Orth)

Consultant Orthopaedic and Paediatric Orthopaedic Surgeon

Llandough Hospital

Vale of Glamorgan

UK

Disclosures

PT declares that he has no competing interests.

Young-Jo Kim, MD, PhD

Associate Professor of Orthopaedic Surgery

Children's Hospital

Boston

MA

Disclosures

Not declared.

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