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Coxa PlanaI.Definition
Legg-Calve-Perthes disease is when the head of the thighbone (femur) inthe hip deteriorates due to insufficient blood supply to the area.
II.AKA (also known as)
Legg-Calve-Perthes disease; Perthes disease
III.Incidences
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United StatesOne in 1200 children younger than 15 years is affected by LCPD.
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RaceCaucasians are affected more frequently than persons of other races.
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SexMales are affected 4-5 times more often than females.
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AgeLCPD most commonly is seen in persons aged 3-12 years, with amedian age of 7 years.
IV.Risk/ Predisposing Factors
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Legg-Calve-Perthes disease occurs most frequently in boys 4 to 10 yearsold. Recent research shows that this disorder may reflect subtle disordersof blood clotting.
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Risk group also includes those who have abnormalities in genetics,hormonal changes, trauma, infection and metabolic abnormalities
 
V.Manifestations
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Knee pain (may be the only symptom, initially)
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Persistent thigh or groin pain
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Atrophy (wasting) of muscles in the upper thigh
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Slight shortening of the leg, or legs of unequal length
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Hip stiffness restricting movement in the hip
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Difficulty walking, walking with a limp (which is often painless)
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Limited range of motion
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Decreased range of motion (ROM), particularly with internal rotation andabduction
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Painful gait
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Muscle spasm
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Leg length inequality due to collapse
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Thigh atrophy: Thigh circumference on the involved side will be smaller than on the unaffected side secondary to disuse.
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Short stature: Children with LCPD often have delayed bone age.
VI.Type/Stage/Classifications of the Disease
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Stage I (avascularity)The blood supply to the upper femoral epiphysis is haltedspontaneously and bone growth is halted (lasts a few weeks)
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Stage II (revascularization)New blood vessels arise to supply the necrotic area, and boneresorption and deposition take place (lasts everal months to 1 year)However the new bone lacks strength and pathologic fractures may occur;the weakened epiphysis may be progressively deformed
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Stage III (reossification)The head of the femur gradually reforms as dead bone is replacedwith new bone, which gradually spreads to heal the lesion (lasts 2 toyears)
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Stage IV (postrecovery)The femoral head becomes permanently distorted, with resultant joint misalignment
 
VII.Pathophysiology
Idiopathic avascular necrosis of femoral headGoes through 5 phases:(1) Initial - histological evidence of dead bone with disappearance of osteocytes fromempty lacunae(2) Early - incipient revascularization(3) early intermediate - active resorption of dead bone along with new bone deposits(4) late intermediate- decreased bone resorption and increasing immature boneformation(5) formation of mature haversian systems.The newly healed epiphysis may be left with residual deformity and never regain atotally normal shape and appearance. Residual deformity can lead to serious disabilitylater in life.Some flattening of the epiphysis, referred to as “coxa plana,” can occur. Inmore severe disease, complete collapse can occur, with the femoral head mushroomingaround the femoral neck. Because younger patients have more growth potential for reformation and remodeling of bone, they tend to have better outcomes.
VIII.Diagnostic Studies
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Laboratory StudiesLaboratory studies for Legg-Calv é -Perthes disease include thefollowing:
CBC
Erythrocyte sedimentation rate - May be elevated if infectionpresent
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