Legg-Calve-Perthes Disease

Abstract

Legg-Calve-Perthes disease (LCPD) is a self-limiting disorder of childhood characterised by interruption of blood supply to the capital femoral epiphysis, which can result in deformation of the femoral head during a protracted period of revascularization. This, in turn, can lead to development of premature degenerative arthritis in early adult life. The primary aim of treatment of LCPD should be to preserve femoral head sphericity. Since the prime factor leading to deformation is epiphyseal extrusion, the cornerstone of management involves ensuring “containment” of the femoral epiphysis within the acetabulum and preserving range of hip motion. Most importantly, if containment is to succeed in preventing femoral head deformation treatment should be instituted early in the course of the disease. Although there is little disagreement on these principles, the choice of the method of containment remains controversial with paucity of high quality evidence to support any particular approach. The goal of this chapter is to provide a comprehensive review of the most up-to-date evidence on the diagnosis and management of LCPD in children, while incorporating the author’s philosophy.