Legg-Calvé-Perthes Disease (LCPD)
Legg-Calvé-Perthes Disease (LCPD)
Definition
Legg-Calvé-Perthes Disease is an idiopathic avascular necrosis (osteonecrosis) of the capital femoral epiphysis in children, characterized by a temporary loss of blood supply to the femoral head, resulting in bone death and eventual remodeling.
Epidemiology
- Demographics:
- Peak age: 4-8 years
- Male:Female ratio 4:1
- Bilateral in 10-20% cases
- More common in Caucasians
- Risk Factors:
- Family history
- Second-hand smoke exposure
- Low socioeconomic status
- Delayed skeletal maturation
- Associated Conditions:
- Attention deficit disorder
- Growth hormone deficiency
- Coagulation abnormalities
- Skeletal dysplasias
Pathophysiology & Staging
Disease Mechanism
- Vascular Events:
- Interruption of blood supply
- Multiple infarction episodes
- Repetitive injury pattern
- Revascularization process
Waldenstrom Classification (Radiographic Stages)
- Stage I (Initial):
- Capital epiphyseal necrosis
- Increased density
- Maintained height
- Stage II (Fragmentation):
- Subchondral fracture
- Lateral subluxation
- Head collapse
- Stage III (Reossification):
- New bone formation
- Healing pattern
- Shape changes
- Stage IV (Remodeling):
- Final shape established
- Residual deformity
- Growth completion
Clinical Features
Presenting Symptoms
- Primary Complaints:
- Painless limp
- Hip/knee/thigh pain
- Limited range of motion
- Morning stiffness
- Physical Findings:
- Antalgic gait
- Trendelenburg sign
- Limited internal rotation
- Thigh atrophy
Clinical Assessment
- Range of Motion:
- Decreased abduction
- Limited internal rotation
- Fixed flexion deformity
- Pain at extremes
- Gait Analysis:
- Short stance phase
- Trendelenburg gait
- Compensatory mechanisms
Imaging & Classification
Radiographic Evaluation
- Standard Views:
- AP pelvis
- Frog-leg lateral
- False profile view
- Abduction/adduction views
- Key Findings:
- Sclerosis
- Fragmentation
- Subchondral fracture
- Head collapse
Classification Systems
- Catterall Classification:
- Group I: <25% involvement
- Group II: 25-50% involvement
- Group III: 50-75% involvement
- Group IV: Total head involvement
- Lateral Pillar (Herring) Classification:
- Group A: No collapse
- Group B: <50% collapse
- Group C: >50% collapse
Advanced Imaging
- MRI:
- Early diagnosis
- Extent assessment
- Containment evaluation
- Prognostic value
- Bone Scan:
- Early detection
- Revascularization assessment
- Disease progression
Treatment Approaches
Treatment Principles
- Goals:
- Pain relief
- Maintain motion
- Prevent deformity
- Preserve sphericity
- Containment Concept:
- Maintain femoral head coverage
- Prevent lateral subluxation
- Guide remodeling
Conservative Management
- Physical Therapy:
- Range of motion exercises
- Muscle strengthening
- Gait training
- Activity modification
- Bracing:
- Containment orthosis
- Scottish Rite brace
- Petrie cast
Surgical Interventions
- Containment Procedures:
- Femoral osteotomy
- Pelvic osteotomy
- Combined procedures
- Shelf acetabuloplasty
- Salvage Procedures:
- Cheilectomy
- Arthrodiastasis
- Hip arthroscopy
Prognosis & Complications
Prognostic Factors
- Age-Related:
- Better <6 years
- Poor >8 years
- Skeletal age impact
- Disease-Related:
- Extent of involvement
- Lateral pillar height
- Containment status
- Range of motion
Complications
- Early:
- Joint stiffness
- Muscle contractures
- Leg length discrepancy
- Pain persistence
- Late:
- Early osteoarthritis
- Femoral head deformity
- Hip impingement
- Need for total hip replacement
Follow-up Care
- Monitoring Schedule:
- Regular radiographs
- Range of motion checks
- Activity modification
- Long-term surveillance
- Patient Education:
- Activity restrictions
- Exercise program
- Warning signs
- Future implications
