Legg-Calvé-Perthes' disease is characterised by a phenotype of short stature, delayed bone age, and hyperactivity.
Although several aetiologies have been proposed, a multi-factorial involvement is most likely.
Typically unilateral, though bilateral involvement is present in 10% of cases.
Clinical features include a limping gait and hip pain frequently radiating into the thigh, knees, groin, or buttocks. Pain worsens during activities.
Treatment is age-dependent. Options include mobilisation and monitoring, non-surgical or surgical containment, or salvage procedures.
A self-limiting disease of the femoral head comprising necrosis, collapse, repair, and re-modelling that presents in the first decade of life and is more commonly seen in boys. The cause is hypothesised to be single or multiple vascular events, followed by re-vascularisation. In later life, it can lead to a painful and poorly functioning hip. The disease was first described independently by Jacques Calvé, Arthur T. Legg, and Georg Perthes in 1910.
History and exam
Key diagnostic factors
- presence of risk factors
- limited range of motion at the hip joint
Other diagnostic factors
- short stature
- muscle wasting
- Trendelenburg's sign
- knee pain
- thigh pain
- groin/buttock pain
- asymmetric limb length
- minor trauma
- 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
1st investigations to order
- bilateral hip x-rays
Investigations to consider
- serum erythrocyte sedimentation rate
- serum C-reactive protein
- bone scintigraphy
- MRI of hips
with acute pain
under 5 years
5 to 7 years
over 7 years to 12 years
over 12 years
Andrew Wainwright, FRCS (Tr & Orth) Med
Consultant Orthopaedic Surgeon
Nuffield Orthopaedic Centre
AW declares that he has no competing interests.
Dominique Knight, BSc, MBBS, FRCS
Consultant Paediatric Orthopaedic Surgeon
Bristol Royal Children’s Hospital
DK declares that she has no competing interests.
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.
Phillip Thomas, FRCS (Orth)
Consultant Orthopaedic and Paediatric Orthopaedic Surgeon
Vale of Glamorgan
PT declares that he has no competing interests.
Young-Jo Kim, MD, PhD
Associate Professor of Orthopaedic Surgery
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