Legg-Calve-Perthes disease

Background

• Avascular necrosis of femoral head
  • Capital femoral epiphysis fails to grow because of lack of blood supply
• Affects children 4-9yr old
• Male:female 4:1
• Bilateral in 10%

Clinical Features

• Insidious onset of mild hip pain and limp
  • May have painless limp
  • May have referred pain to groin, thigh, knee
• Pain often exacerbated by activity, relieved with rest
• Decreased hip abduction and internal rotation

Differential Diagnosis

Pediatric hip pain

• Septic arthritis of the hip (peds)
• Slipped capital femoral epiphysis
• Legg-Calve-Perthes disease
• Transient (toxic) synovitis
• Acute rheumatic fever
• Juvenile idiopathic arthritis
• Developmental dysplasia of hip
• Femur fracture

Evaluation

• Plain radiographs of the hip
  • May be normal early in disease
  • If high suspicion obtain bone scan or MRI
• Imaging findings:
  • Widening of cartilage space of affected hip
  • Small size ossific nucleus of femoral head
  • Subchondral stress fracture line in femoral head

Management

• Orthopedic surgery consultation
• Non-weight bearing
• Protection of hip joint (maintain in abduction and internal rotation)

Disposition

• Generally may be discharged
  • Should be done in consultation with orthopedic surgery to ensure appropriate therapy and close follow-up

See Also

• Pediatric hip pain

References

Authors

Ross Donaldson