Hip4 – 8 years
Legg-Calvé-Perthes Disease
Idiopathic avascular necrosis of the proximal femoral epiphysis in children, leading to a self-limited sequence of necrosis, fragmentation, reossification, and remodeling.
Presentation
- Painless or mild limp, often referred to the knee or thigh
- Decreased hip abduction and internal rotation
- More common in boys, typically unilateral
Imaging & Workup
- AP and frog-leg lateral radiographs show flattening and fragmentation
- Lateral pillar (Herring) classification guides prognosis
- MRI useful for early diagnosis before radiographic changes
Treatment
Observation & ROM
Younger children with good containment; maintain motion.
Containment
Bracing or femoral/pelvic osteotomy in older or severe cases.
Clinical Pearls
- Age at onset is the strongest prognostic factor (< 6 yrs does best)
- Goal is a congruent, spherical, contained femoral head