Skeletal immaturity, rostral sparing, and disparate hip morphologies as biomechanical causes for Legg‐Calvé‐Perthes' disease

Abstract

Legg-Calvé-Perthes' (Perthes') disease is a developmental disease of the hip joint that may result in numerous short and long term problems. The etiology of the disease remains largely unknown, but the mechanism is believed to be vascular and/or biomechanical in nature. There are several anatomical characteristics that tend to be prevalent in children with Perthes' disease, namely: skeletal immaturity, reduced height, and rostral sparing. We present an overview of the literature, summarizing the current understanding of the pathogenesis, particularly related to how the formation of the vasculature to the femoral epiphysis places children aged 5-8 at a higher risk for Perthes' disease, how skeletal immaturity and rostral sparing could increase the probability of developing Perthes' disease, and how animal models have aided our understanding of the disease. In doing so, we also explore why Perthes' disease is correlated to latitude, with populations at higher latitudes having higher incidence rates than populations closer to the Equator. Finally, we present five hypotheses detailing how Perthes' disease could have a biomechanical cause. Clin. Anat. 29:759-772, 2016. © 2016 Wiley Periodicals, Inc.

Adult paleopathology as an indicator of childhood social roles: A case study of Perthes disease in a native Ohio female

“…During childhood, the femoral head is supplied exclusively by the medial circumflex artery (Berthaume et al, ). In the first stage of LCPD, blood flow to the medial circumflex artery is restricted (Berthaume et al, ).…”

“…During childhood, the femoral head is supplied exclusively by the medial circumflex artery (Berthaume et al, ). In the first stage of LCPD, blood flow to the medial circumflex artery is restricted (Berthaume et al, ). Although the precise aetiology of the ischemia is unknown (Alpaslan, Aksoy, & Yazici, ), such restriction can be caused by extension of the hip (e.g., standing), which stretches the medial circumflex artery over the tendon of the external obturator (Lauritzen, ).…”

“…Children in whom the medial circumflex artery lies deep to the external obturator tendon are at an elevated risk for artery restriction because the artery can become entrapped within the external obturator tendon and the joint capsule of thLauritzene hip (Lauritzen, ). The restriction of the medial circumflex artery reduces blood supply to the femoral head and weakens the bone, which then fractures in the second stage (Berthaume et al, ). The ligamentum teres and the cartilage between the femoral head and the acetabulum swells, and although the bone will later heal, the abnormal weight distribution will result in deformation of the femoral head (Gill, ).…”

“…The ligamentum teres and the cartilage between the femoral head and the acetabulum swells, and although the bone will later heal, the abnormal weight distribution will result in deformation of the femoral head (Gill, ). When the child reaches the age of about seven or eight, the femoral head is revascularised as the acetabular branch of the obturator artery begins to supply it (Berthaume et al, ). The bone is rejuvenated and then heals (Waldron, :210‐213, Berthaume et al, ).…”

New insights into the biomechanics of Legg-Calvé-Perthes’ disease

“…We have previously proposed five mechanisms for the pathology of Perthes’ disease, 15 and the implications for the morphology of the juvenile hip and the biomechanics of the hip joint. 16 From these we suggested that fracture and collapse of the femoral head, even in an immature epiphysis, is unlikely.…”