Legg-Calvé-Perthes Disease: A Review of Cases with Onset Before Six Years of Age

Rosenfeld, Scott B.; Herring, John A.; Chao, John C.
December 2007
Journal of Bone & Joint Surgery, American Volume;Dec2007, Vol. 89-A Issue 12, p2712
Academic Journal
Background: The prognosis for children in whom Legg-Calvé-Perthes disease develops before the age of six years was initially reported to be good, but later studies demonstrated a less favorable prognosis. To assess the natural history of this condition in this age group, we reviewed a large cohort of children who had received minimal treatment for the disease. Methods: The medical records and radiographs of all children with Legg-Calvé-Perthes disease seen at our institution between 1944 and 2000 were reviewed. The cases of 172 patients with a total of 188 affected hips were studied. The course of the disease and the final clinical and radiographic outcomes were evaluated in all patients. Results: Typical Legg-Calvé-Perthes disease was noted in 164 hips of 160 patients. According to the lateral patellar classification, seven of these hips were in group A; 101, in group B; twenty-seven, in the B/C border group; and twenty-nine, in group C. According to the Stulberg classification, there were 131 Class-I or II (good) results, fourteen Class-Ill (fair) results, and nineteen Class-IV (poor) results. The lateral pillar classification was highly correlated with the outcome, whereas treatment did not correlate with the outcome. Only lateral pillar group-B/C border and C hips with an onset of the disease between the ages of four years and five years and eleven months had a poor prognosis. We unexpectedly encountered a group of twelve patients with bilateral, simultaneous development of apparent Legg-Calvé-Perthes disease. In that group, there were twenty-one Stulberg Class-I or II (good), three Stulberg Class-Ill (fair), and no Stulberg Class-IV (poor) results, although fourteen of the twenty-four hips were in lateral pillar group C. The outcome in the hips in lateral pillar group C was significantly better when the patient had bilateral simultaneous involvement than when the patient had typical Legg-Calvé-Perthes disease. Conclusions: The prognosis for patients with the onset of Legg-Calvé-Perthes disease before the age of six years is favorable, with 80% having a good result. Only children between the ages of four years and five years and eleven months with a B/C or C lateral pillar classification of involvement have a less favorable prognosis. Treatment was not found to influence outcome. Simultaneous bilateral disease, which had a more favorable prognosis, may represent a unique disorder.


Related Articles

  • LEGG-CALVÉ-PERTHES DISEASE. Herring, John A.; Hui Taek Kim; Browne, Richard // Journal of Bone & Joint Surgery, American Volume;Oct2004, Vol. 86-A Issue 10, p2103 

    Background: Accurate and reliable radiographic classifications of the relative severity and outcome of Legg-Calvé-Perthes disease are essential in the study of that disease. As part of a prospective multicenter study*, we sought to define more clearly the lateral pillar classification of...

  • LEGG-CALVÉ-PERTHES DISEASE. Herring, John A.; Hui Taek Kim; Browne, Richard // Journal of Bone & Joint Surgery, American Volume;Oct2004, Vol. 86-A Issue 10, p2121 

    Background: The treatment of Legg-Calvé-Perthes disease has been based on uncontrolled retrospective studies with relatively small numbers of patients. This large, controlled, prospective, multicenter study was designed to determine the effect of treatment and other risk factors on the...

  • The 100 Classic Papers of Pediatric Orthopaedic Surgery. Kavanagh, R.G.; Kelly, J.C.; Kelly, P.M.; Moore, D.P. // Journal of Bone & Joint Surgery, American Volume;9/18/2013, Vol. 95-A Issue 18, p1726 

    Background: Pediatric orthopaedic surgery owes its development to many pioneering individuals, and the studies that these individuals have undertaken form the basis for the clinical decisions made on the modern pediatric orthopaedic service. The aim of our study was to use citation analysis to...

  • Rotational open-wedge osteotomy improves treatment outcomes for patients older than eight years with Legg-Calve-Perthes disease in the modified lateral pillar B/C border or C group. Nakamura, Naoyuki; Inaba, Yutaka; Machida, Jiro; Saito, Tomoyuki // International Orthopaedics;Jul2015, Vol. 39 Issue 7, p1359 

    Purpose: Since 2003, we have been performing rotational open-wedge osteotomy (ROWO) for older children with severe Legg-Calve-Perthes disease (LCPD). We compared the treatment outcomes before and after the introduction of ROWO for patients aged ≥ eight years, classified in the modified...

  • Waldenström's disease.  // Taber's Cyclopedic Medical Dictionary;2005, p2340 

    A definition of the term "Waldenström's disease" is presented. It refers to Osteochondritis deformans juvenilis.

  • 128 Limping Children with No Fracture, Sprain, or Obvious Cause. Illingworth, Cynthia M. // Clinical Pediatrics;Feb1978, Vol. 17 Issue 2, p139 

    The article discusses the cases of limping children in a pediatric's hospital in Sheffield, England. The children showed no signs of fracture, sprain or any obvious causes. The special diagnostic procedures done were white cell count, differential, sedimentation rate, throat culture, with x-rays...

  • Impeded Venous Drainage from the Bone Marrow of the Femoral Head: A Synthesis. Arnoldi, Carl C. // Vascular Surgery;Mar1990, Vol. 24 Issue 2, p97 

    This paper is a synthesis of the results of research on intraosseous circulation in the proximal end of the femur in children (Perthes' disease) and adults (degenerative osteoarthritis, the intraosseous engorgement-pain syndrome, nontraumatic femoral head necrosis). These disorders are all...

  • Legg-Calvé-Perthes disease. Orban, Horia Bogdan; Adam, Razvan // Maedica - a Journal of Clinical Medicine;2007, Vol. 2 Issue 2, p133 

    Legg-Calvé-Perthes disease is a form of idiopathic avascular necrosis of the femoral head, evolving to classical "coxa plana", which will lead to secondary hip arthritis. Legg-Calve-Perthes syndrome occurs most commonly in boys than in girls by a ratio of 4 to 1, commonly in the age range of...

  • The incidence and distribution of Legg -- Calvé-- Perthes' disease in Liverpool, 1982-95. Margetts, B. M.; Perry, C. A.; Taylor, J. F.; Dangerfield, P. H. // Archives of Disease in Childhood;Apr2001, Vol. 84 Issue 4, p351 

    Aims-To determine the incidence and distribution of Legg-Calvé-Perthes' disease in Liverpool, in the period 1982-95. Methods-Examination of information in a register, analysing the patients' ad- dresses by indices of deprivation. Results-A total of 122 white children were diagnosed as having...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics