Legg Calve Perthes disease is avascular necrosis of the femoral head in children, most commonly affecting boys ages 4-8. It has an unknown cause but may be associated with conditions like ADHD. Presentation includes a limp or hip/thigh pain. X-rays show changes in the femoral head over time. Treatment depends on age and classification, ranging from observation to osteotomies, with the goal of containing the femoral head to prevent deformity and future arthritis. Prognosis is worse with older age at onset and decreased hip range of motion. Complications can include femoral head deformity, collapse, and leg length discrepancy.

1. Legg calve perthes disease
By: Ala’a AlGhanem | 211508057 | B1

2. Learning Objectives:
 Normal anatomy of hip joint.
 Introduction and epidemiology
 Aetiology and classifications
 Clinical presentation
 Investigations
 Treatment and prognosis
 Complications

3. Anatomy of hip joint:

5. Legg calve perthes disease
Idiopathic avascular necrosis of the proximal femoral epiphysis in
children
Legg Calve Perthes

6. Epidemiology:
2-Sex:
1-incidence:
affects 1 in 1200 children
>
5 : 1

7. 3-Age
4-8 years is most common age of presentation
4-Population:
more commonly seen in urban populations versus rural
5-Location:
bilateral in 12% ( never at the same stage of disease)

8. the exact cause of disruption of blood supply remains
unknown.
Etiology:
Associated conditions:
-ADHD (33%)
-delayed bone age (98%)
-Thrombophilia (50%)

9. how Avascular necrosis (AVN) develops:

10. Risk Factors:
1-positive family history
2-low birth weight
3-abnormal birth presentation
4-children exposed to second hand
smoke
5-Asian, Inuit, and Central European
decent

11. Classifications:
 Waldenström
 Lateral Pillar (Herring ) Classification
 Catterall Classification
 Salter-Thompson classification
 Stulberg classification

12. Stages of Legg-Calves-Perthes
(Waldenström)
Initial stage
(infarction)
Fragmentation
Reossification
Healing or
remodeling

13. Lateral Pillar (Herring ) Classification
Determined at the beginning of fragmentation stage
lateral pillar
maintains full
height
Maintains
>50% height
Maintains
<50% height

14. Catterall Classification
Based on degree of head involvement

15. Salter-Thompson classification
Based on radiographic cresent sign
crescent sign involves < 1/2 of
femoral head
crescent sign involves > 1/2 of
femoral head
Class A
Class B

16. Stulberg classification
normal
Spherical head
with enlargement,
short neck, or
steep acetabulum
Nonspherical
head
Flat head Flat head with
incongruent hip joint
Gold standard for rating residual femoral head deformity and joint
congruence

17. Clinical presentation:
-insidious onset
-may cause
painless limp
-intermittent
knee, hip, groin
or thigh pain
Physical Exam:
Symptoms:
-Trendelenburg gait
-antalgic limp
limb length
discrepancy is a late
finding
-hip stiffness with loss
of internal rotation
and abduction
-gait disturbance:

18. Investigations:
 Plain radiographs:
AP of pelvis and frog leg laterals
early findings include:
 medial joint space widening (earliest)
 irregularity of femoral head ossification
 cresent sign (represents a subchondral fracture)

19. MRI
can provide early diagnosis revealing alterations in the
capital femoral epiphysis and physis.
 Bone scan:
can confirm suspected case of LCP
decreased uptake (cold lesion) can predate changes on radiographs
Arthrogram
a dynamic arthrogram can demonstrate coverage and containment
of the femoral head

20. Differential Diagnosis
 multiple epiphyseal dysplasia
 spondyloepiphyseal dysplasia
 sickle cell disease
 Gaucher disease
 hypothyroidism
 Meyers dysplasia

21. Treatment:
 The main Goals of treatment:
 1-keep the femoral head contained and
maintain good motion
 2-containment limits deformity and minimizes loss
of sphericity and lessen subsequent
degenerative changes.

22. Non-operative:
observation alone, activity restriction, and physical therapy
Indications:
1-children < 8 years of age
2-children with lateral pillar A
3-consider activity restriction and protected weight-bearing
during earlier stages until reossification is complete

23. techniques:
Cast Brace

24. Operative:
 Femoral or pelvic osteotomy
Indications:
1-children > 8 years of age, especially lateral pillar B and B/C
improved outcomes with surgery for lateral pillar B and B/C in
children > 8 years
poor outcome for lateral pillar C regardless of treatment.

25. Pelvic osteotomy:
 Dega Osteotomy
 Salter (Innominate) Osteotomy

26. Femoral osteotomy:
 Varus femoral osteotomy

27. Prognosis:
 prognosis worse with:
1-age (bone age) > 6 years at presentation
2-female sex
3-decreased hip range of motion (abduction)
 prognosis improved with:
1-age (bone age) < 6 years at presentation

28. Complications:
 The head of the femur may lose its normal, spherical
shape and/or collapse.
 Also, degenerative joint disease can occur (i.e. as
occurs in osteoarthritis).
 The affected leg may lose some of its motion and may
become shorter than the normal leg.

29. References:
Johns Hopkins Pediatric Orthopaedics
Patient

30. Thank You