LEGG CALVE

PERTHES
DISEASE
EPIDEMIOLOGY
• Disorder of the hip in young children
• Usually ages 4-8yo
• As early as 2yo, as late as teens
• Boys:Girls= 4-5:1
• Bilateral 10-12%
• No evidence of inheritance
ETIOLOGY

• Idiopathic

• Past theories
–Infection, inflammation, trauma, congenital

• Most theories involve vascular compromise

PATOLOGY

Stage1 Stage 2 Stage 3

• Ischaemia and bone • Revascularization and • Distortion and

death, cartilage thickens
repair remodelling
• Dead marrow replaced • Restoration of femoral
by granulation tissue archtecture or collapse
• Bone revascularized • Femoral head displaces
and new bone laid laterally in relation to
down acetabulum
• Dead bone resorbed,
replaced by fibrous
tissue, fragmentation
 Decreased ROM,
especially
abduction and
internal rotation

Trendelenburg
Limb length
test often
CLINICAL
discrepency
positive

MANIFESTATION

Muscular atrophy
Adductor
of
contracture
thigh/buttock/calf
IMAGING

• AP pelvis
• Frog leg lateral
• Key= view films sequentially
over course of dz
• Arthrography
• MRI role undefined
TREATMENT

Conservative Containment

• Pain control • Hold hips widely abducted in

• Gentle exercises cast/brace >1yr
• Regular re-assessment • Operation
• Avoid sport and strenous • Varus osteotomy of femur
activities • Innominate osteotomy of
pelvis
• Both
PROGNOSIS

• 60% of kids do well without tx

• AGE is key prognostic factor:
– <6yo= good outcome regardless of tx
– 6-8yo= not always good results with just containment
• >9yo= containment option is questionable, poorer prognosis, significant residual defect
• Flat femoral head incongruent with acetabulum= worst prognosis
• Do not treat in reossification stage (>15mos)
 Coxa magna

Physeal arrest patterns

COMPLICATION
Irregular head formation

Osteochondritis dessicans