Legg-Calvé-Perthes disease: Diagnostics and contemporary treatment

Abstract

Legg-Calvé-Perthes disease represents avascular necrosis of the femoral head in a growing child. It commonly affects children aged 2-14 years, mostly boys, and has familiar pattern. The etiology of this disease is unknown. It is based on avascular necrosis due to variations of the femoral head vascular supply, trauma, coagulation of endocrine disturbances. The disease presents with limping and pain localized in the hip with projection to thigh and knee, frequently accompanied by the limitation of abduction and internal rotation, as well as slight limitation in flexion of about 20 degrees. Plain radiography is most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage and the extent of disease. Main treatment goal is obtaining the spherical congruity of the hip joint. This can be achieved by abduction bracing, varization femoral osteotomies and various innominate osteotomies (sometimes combined with femoral osteotomies). Children younger than four years of age, with minimal femoral head involvement, do not need any treatment. These children with a larger involvement, older than four years of age, with possible containment in hip abducion, should be treated by one of the following procedures: Salter innominate osteotomy, Salter innominate osteotomy with femoral shortening, or triple pelvic osteotomy. The patients with containment of the hip is not possible in abduction (related to subluxation and femoral head crush), should be treated by Chiari pelvic osteotomy.

Bernese-type triple pelvic osteotomy through a single incision in children over five years: a retrospective study of twenty eight cases

“…In contrast, the results were worse in patients with LCPD, who had good clinical and radiographic outcomes in only 57.1% of cases. However, this percentage is similar to that of other published studies [20][21][22]. In particular, a similar rate of good results (42 to 58%) was reported by Camurcu [23], Pailhé [1], Wenger [24], and Vukasinovic [25].…”

Legg–Calvé–Perthes disease overview

“…Recently, a fourth group has been proposed between groups B and C, in which the lateral abutment is narrow, poorly ossified or maintains 50% of its height (Fig. 3 ) [ 22 , 23 ].…”

Reabilitação física em portadores de Legg-Calvé-Perthes após osteotomia de Salter – protocolo de orientação domiciliar

“…Desde 1910, quando Legg, Calvé e Perthes descreveram a osteonecrose juvenil da cabeça femoral, também chamada de doença de Legg-Calvé-Perthes, tem-se dado importância a utilização de exercícios terapêuticos no seu tratamento 14 . Vários autores citam a fisioterapia, referindo-se aos procedimentos conservadores de tratamento ou à sua indicação no pós-operatório 5,9,10,14,15,19,20 .…”