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Legg–Calvé–Perthes disease

Medically Reviewed

A childhood hip disorder due to avascular necrosis of the femoral head.

Overview

Legg–Calvé–Perthes disease (LCPD) is a rare childhood condition that affects the hip joint, specifically the femoral head-the ball portion of the thigh bone that fits into the hip socket. The disease involves a temporary disruption of blood supply to the femoral head, leading to avascular necrosis (bone tissue death). Over time, the bone may collapse and then gradually regenerate. LCPD usually affects children between the ages of 4 and 10 and is more common in boys than girls. It can affect one or both hips, though unilateral involvement is more common.

Causes

The exact cause of Legg–Calvé–Perthes disease is unknown. It is believed to result from an interruption of blood flow to the femoral head, but the trigger for this vascular disruption is unclear. Potential contributing factors may include:

  • Genetic predisposition – a family history may increase the risk

  • Trauma or repetitive stress – may contribute in some cases

  • Coagulation abnormalities – increased tendency for blood clotting could impair circulation

  • Delayed skeletal maturation – children with slower bone development may be at higher risk

  • Environmental or socioeconomic factors – such as low birth weight or exposure to tobacco smoke

Symptoms

Symptoms of LCPD typically develop gradually and may vary depending on the stage and severity of the disease. Common signs and symptoms include:

  • Hip pain – may radiate to the groin, thigh, or knee

  • Limping – often painless in the early stages

  • Stiffness or limited range of motion – particularly in hip abduction and internal rotation

  • Muscle wasting – especially around the upper thigh due to disuse

  • Leg length discrepancy – in advanced or bilateral cases

Symptoms usually worsen with activity and improve with rest.

Diagnosis

Diagnosis of Legg–Calvé–Perthes disease involves a combination of physical examination and imaging studies. Key diagnostic steps include:

  • Clinical evaluation – including assessment of gait, hip mobility, and limb length

  • X-rays of the pelvis and hips – the primary tool to detect changes in the femoral head

  • MRI – more sensitive in early stages when X-rays may appear normal

  • Bone scan – may help assess blood flow and necrosis in the femoral head

Imaging helps stage the disease, which is important for prognosis and treatment planning.

Treatment

Treatment of LCPD focuses on preserving the shape of the femoral head and maintaining hip joint function as the bone regenerates. The approach depends on the child's age, severity of the disease, and degree of femoral head involvement. Options include:

  • Non-surgical management (for younger children or mild cases):

    • Activity modification and rest

    • Physical therapy to maintain hip range of motion

    • Anti-inflammatory medications for pain and inflammation

    • Bracing or casting to contain the femoral head within the hip socket

  • Surgical treatment (for older children or severe cases):

    • Osteotomy – surgical reshaping of the femur or pelvis to improve joint congruency

    • Removal of loose bone fragments or debris from the joint

Prognosis

The long-term outlook for children with Legg–Calvé–Perthes disease varies. Many children recover with little to no long-term disability, especially if diagnosed and treated early. Factors that influence prognosis include:

  • Age at onset – children younger than 6 generally have better outcomes

  • Extent of femoral head involvement – less damage correlates with better prognosis

  • Response to treatment – maintaining joint mobility improves outcomes

Some children may develop long-term complications such as osteoarthritis or hip deformity in adulthood. Regular follow-up and early orthopedic intervention help improve functional outcomes and reduce complications.

Medical Disclaimer

The information provided on this page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.