Legg-Calvé-Perthes Disease: Past and Present

Abstract

Legg–Calvé–Perthes disease (LCPD) is a rare idiopathic condition that primarily affects the femoral head. It is characterized by a sudden necrosis, which leads to permanent and irreversible changes of its normal anatomy. Likely due to its rarity and complex etiology, there is a lacuna of its study in archaeological literature. This paper attempts to address this issue by aiming to (1) gather all known examples of LCPD in the archaeological record worldwide; (2) based on etiological speculation, analyze how individuals may have developed LCPD in the past; (3) assess how LCPD may have affected these individuals; and (4) how they may have managed the effects. In this study, a wide range of resources pertaining to archaeology, osteology, paleopathology, and clinical studies were consulted. The information was extracted from a number of available case studies and osteological site reports despite data-access difficulties. In the archaeological record, there are 73 reported cases of LCPD affecting individuals, spanning from the Neolithic to the Postmedieval period, across the globe, with its highest peak in the Late Medieval period. Modern clinical literature has provided an empirical platform to investigate what may have caused LCPD in the past, though etiological conjecture continues to prevent any certainty in these extrapolations. The resulting prevalence of the cases of LCPD are also skewed by issues concerning skeletal preservation and inaccessible data, ultimately affecting its representation and the evaluation of the disease's laterality and sex preponderance. Nonetheless, physical debilitation caused by LCPD would have variably inhibited the individuals' mobility, causing pain, compromised quality of life, decline in mental state, and an inability to fully engage in ambulatory activities. However, coexisting osteological markers suggest methods of managing the disease's symptoms, such as resorting to an antalgic gait and/or using upper limb apparatus (crutch).