INTRODUCTION

Legg-Calvé-Perthes disease (LCPD) is an idiopathic juvenile avascular necrosis of the femoral head in a
skeletally immature patient, i.e. children. Legg-Calvé and Perthes discovered this disease approximately
100 years ago. The disease affects children from ages of two to fourteen. The disease can lead to
permanent deformity and premature osteoarthritis

https://www.physio-pedia.com/Legg-Calve-Perthes_Disease

INTRODUCTION

Legg-Calve-Perthes disease (LCPD) is idiopathic osteonecrosis or idiopathic avascular necrosis of the

capital femoral epiphysis of the femoral head. This condition was described independently by Arthur
Legg, Jacques Calve, and Georg Perthes in 1910. This process is also known as coxa plana, Legg-
Perthes, Legg Calve or Perthes disease.
https://www.ncbi.nlm.nih.gov/books/NBK513230/

EPIDEMIOLOGY

LCPD is an idiopathic disease, but a variety of theories about the underlying cause have
been proposed since its discovery over a century ago, ranging from congenital to
environmental and from traumatic to socio-economic causes. LCPD has been associated
with thrombosis, fibrinolysis, and abnormal growth patterns of the bone . It has also been
associated with an abnormality in the Insulin-like Growth Factor-1 Pathway, repeated
mircotrauma or mechanical overloading related to hyperactivity of the child or a very low
birth weight or short body length at birth.

Some studies suggest a genetic factor, i.e. a type II collagen mutation,  and other studies
report maternal smoking during pregnancy as well as other prenatal and perinatal risk
factors.

It may be be that LCPD requires a set or subset of the aforementioned causes. As of yet it
is hard to discern which are determining or merely contributing factors to the onset of the
disease.

https://www.physio-pedia.com/Legg-Calve-Perthes_Disease

EPIDEMIOLOGY

Legg-Calve-Perthes disease usually occurs between the ages of 3 to 12 years old, with the highest rate of
occurrence at 5 to 7 years. It affects 1 in 1200 children under the age of 15. Legg-Calve-Perthes
disease occurs most commonly in male patients, with a male to female ratio between 4:1 and 5:1. It is
bilateral in 10% to 20% of affected cases. When it occurs bilaterally, it is usually asymmetrical and
discovered in different stages of the disease. If it is symmetrical, the examiner must consider multiple
epiphyseal dysplasias as the culprit. Caucasians and Asians are more commonly affected. It is also more
prevalent in urban areas in patients with lower socioeconomic status. 

https://www.ncbi.nlm.nih.gov/books/NBK513230/
 Risk factors for Legg-Calve-Perthes disease include:

 Age. Although Legg-Calve-Perthes disease can affect children of nearly any age, it

most commonly begins between ages 4 and 10.

 Your child's sex. Legg-Calve-Perthes is about four times more common in boys than in
girls.

 Race. White children are more likely to develop the disorder than are black children.

 Genetic mutations. For a small number of people, Legg-Calve-Perthes disease

appears to be linked to mutations in certain genes, but more study is needed.
https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-
disease/symptoms-causes/syc-20374343

Risk factors for Legg-Calve-Perthes disease include

 Ten percent familial (there is a delayed bone age by about 2 years)

 HIV (Up to 5% of HIV patients have avascular necrosis of the hip)
 Factor V Leiden and other inherited coagulopathies
 Thrombophilias (increased clotting)
 Hypofibrinolysis (decreased ability to dissolve clots)
 Secondhand smoke exposure (OR=5)
 Low socioeconomic status
 Birth weight less than 2.5 kg in boys
 Short stature

https://www.ncbi.nlm.nih.gov/books/NBK513230/

Physical exam

o hip stiffness
 loss of internal rotation and abduction
o gait disturbance
 antalgic limp
 Trendelenburg gait (head collapse leads to decreased tension of
abductors)
o limb length discrepancy is a late finding
 hip adduction contracture can exacerbate the apparent LLD

https://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease
PHYSICAL EXAM

Imaging tests

These types of tests, which are vital to the diagnosis of Legg-Calve-Perthes disease, might
include:

 X-rays. Initial X-rays might look normal because it can take one to two months after symptoms
begin for the changes associated with Legg-Calve-Perthes disease to become evident on X-rays.
Your doctor will likely recommend several X-rays over time, to track the progression of the
disease.

 MRI. This technology uses radio waves and a strong magnetic field to produce very detailed
images of bone and soft tissue inside the body. MRIs often can visualize bone damage caused by
Legg-Calve-Perthes disease more clearly than X-rays can, but are not always necessary.

https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/diagnosis-treatment/drc-20374348