Legg-Calvé-Perthes Disease

Suspect Legg-Calvé-Perthes disease in a child—most often a boy aged 4 to 10 years—with a limp and activity-related hip or groin pain that may radiate to the thigh, knee, or buttock. Clinical hip restriction and gait change should trigger pelvic and hip imaging even when the presenting complaint is knee pain. BMJ+1BMJLegg-Calvé-Perthes disease - Symptoms, diagnosis and treatment | BMJ Best Practice USPubMedLegg-Calve-Perthes Disease - StatPearls - NCBI Bookshelf

The initial diagnostic branch is whether the child may have an alternative pediatric hip disorder requiring a different urgency and pathway. Slipped capital femoral epiphysis, septic arthritis, inflammatory hip disease, trauma, and malignancy remain competing diagnoses in a limping child; assess the entire lower limb and obtain inflammatory markers when infection or systemic inflammation is clinically plausible. ESR and CRP are among the laboratory tests used in evaluation of pediatric hip pathology. PubMedPubMedLegg-Calve-Perthes Disease - StatPearls - NCBI Bookshelf

Obtain plain radiographs as the baseline study for diagnosis, staging, containment assessment, and serial comparison. Early radiographs can be unrevealing or difficult to classify; MRI can demonstrate early ischemic necrosis, and bone scintigraphic changes may precede radiographic classification changes. PubMed+2PubMedLegg-Calve-Perthes Disease - StatPearls - NCBI BookshelfPubMedSerial bone scintigraphy in Legg-Calvé-Perthes disease: correlation with the Catterall and Herring classification - PubMedjbjsJBJS: The Pathogenesis and Treatment of Legg-Calvé-Perthes Disease

Perthes disease progresses through necrosis, subchondral fracture, fragmentation, revascularization/reossification, and healing/remodeling. The treatment objective during the vulnerable early phases is to keep the femoral head contained by the acetabulum while it repairs, thereby maximizing the chance of a spherical, congruent hip. ScienceDirect+1ScienceDirectOverview of surgical treatments in Legg-Calvé-Perthes disease - ScienceDirectPubMedLegg-Calve-Perthes Disease - StatPearls - NCBI Bookshelf

Use age at clinical onset, extent of epiphyseal involvement, stage, lateral extrusion, hip motion, and femoral-head deformity together rather than relying on a single radiographic label. Older onset confers less remodeling potential and greater residual incongruity; children older than 8 years have poorer overall prognosis, although they may benefit from advanced operative treatment. BMJ+2BMJLegg-Calvé-Perthes' disease - Prognosis | BMJ Best PracticePubMedSurgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review - PubMedjbjsJBJS: The Pathogenesis and Treatment of Legg-Calvé-Perthes Disease

The Herring lateral pillar system is a key severity classification, while Catterall-based assessments have historically been used to estimate femoral-head involvement. In early disease, these radiographic classifications can be difficult to apply; serial radiographs and, when needed, MRI or scintigraphy refine risk assessment before an irreversible treatment decision. BMJ+1BMJLegg-Calvé-Perthes disease - Symptoms, diagnosis and treatment | BMJ Best Practice USPubMedSerial bone scintigraphy in Legg-Calvé-Perthes disease: correlation with the Catterall and Herring classification - PubMed

Initial nonoperative management centers on preserving hip range of motion, reducing painful synovitis when present, modifying activity, and monitoring femoral-head containment. Reported nonsurgical options include physiotherapy, activity modification, traction or recumbency in selected circumstances, and hip-abduction orthoses. Nature+3NatureNature Index Legg-Calvé-Perthes Disease Management and OutcomesScienceDirectLegg-Calvé-Perthes Disease: Treatment and Prognosis - ScienceDirectWolters KluwerNonsurgical Treatment of Legg-Calvé-Perthes Disease : Journal of Pediatric OrthopaedicsPubMedLegg-Calve-Perthes Disease - StatPearls - NCBI Bookshelf

An abduction orthosis is intended to increase anterior and lateral acetabular coverage and keep the vulnerable epiphysis within the acetabulum. However, two major brace-treatment studies found no outcome advantage for bracing over observation or range-of-motion therapy, so bracing should not substitute for serial assessment of extrusion, motion, and radiographic progression. Wolters KluwerWolters KluwerThe Role of Bracing in Legg-Calve-Perthes Disease

For less than half femoral-head involvement with minimal lateral extrusion, traction to regain motion and reduce synovitis has been described as sufficient initial treatment. For half or more involvement without excessive extrusion or other head-at-risk signs, a short course of abduction orthosis may be used; progression to excessive extrusion should prompt reconsideration of containment strategy. ScienceDirectScienceDirectLegg-Calvé-Perthes Disease: Treatment and Prognosis - ScienceDirect

Discuss operative containment early for a child with severe femoral-head involvement and excessive lateral extrusion, especially at older onset. Early-stage operative containment has been associated with improved femoral-head sphericity and better outcomes in multicenter prospective cohort studies, although treatment selection remains influenced by age, severity, disease stage, and preexisting deformity. ScienceDirect+1ScienceDirectLegg-Calvé-Perthes Disease: Treatment and Prognosis - ScienceDirectjbjsJBJS: The Pathogenesis and Treatment of Legg-Calvé-Perthes Disease

Femoral varus osteotomy and pelvic/innominate osteotomy are established containment approaches for noncontainable hips. In children younger than 6 years, pelvic osteotomy has been associated with better radiographic outcomes than femoral osteotomy; from age 6 years onward, femoral and pelvic osteotomies were similarly likely to yield a spherical congruent head in the cited experience. BMJ+1BMJLegg-Calvé-Perthes' disease - Treatment algorithm | BMJ Best PracticePubMedSurgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review - PubMed

In one comparative study, children older than 8 years with lateral pillar B and B/C border hips had significantly better outcomes with surgery than with nonoperative treatment. This is a useful referral-level discriminator rather than a standalone mandate: operative planning must also account for current containment, motion, stage, and head shape. Wolters Kluwer+1Wolters KluwerThe Role of Bracing in Legg-Calve-Perthes DiseasejbjsJBJS: The Pathogenesis and Treatment of Legg-Calvé-Perthes Disease

Serial follow-up should track symptoms, gait, hip range of motion, femoral-head contour, lateral extrusion, and containment on radiographs. The disease evolves through fragmentation, reossification, and healing, so a favorable early examination does not exclude later deformation during the vulnerable phases. PubMed+1PubMedLegg-Calve-Perthes Disease - StatPearls - NCBI BookshelfPubMedSerial bone scintigraphy in Legg-Calvé-Perthes disease: correlation with the Catterall and Herring classification - PubMed

Use age at onset and the geometric extent of femoral-head involvement for early counseling, but use healed congruence and head shape for long-term osteoarthritis risk assessment. Congruence is more predictive of future arthritis than sphericity alone, and Stulberg class provides a framework for estimating adult hip risk. BMJBMJLegg-Calvé-Perthes' disease - Prognosis | BMJ Best Practice

Residual Perthes deformity can lead to painful, poorly functioning hips and secondary degenerative osteoarthritis in later life. In a recent review of diffusion-weighted imaging literature, the cited lifetime total hip arthroplasty rate among patients with Perthes disease was 39%, underscoring the importance of protecting hip morphology during childhood and reassessing symptomatic residual deformity in adolescence or adulthood. ScienceDirect+1ScienceDirectDiagnostic performance of diffusion-weighted imaging (DWI) in Legg-Calvé-Perthes disease: A systematic review and meta-analysisjbjsJBJS: The Pathogenesis and Treatment of Legg-Calvé-Perthes Disease