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Updated: Dec 5 2024

Legg-Calve-Perthes Disease

Images
  • summary
  • Epidemiology
  • Etiology
  • Classification 
  • Presentation
  • Imaging
  • Studies
  • Differential
  • Treatment
    • Goals
      • resolution of symptoms
        • NSAIDs, traction, crutches
      • restoration of range of motion
        • physical therapy (may exacerbate symptoms), muscle lengthenings, Petrie casting
      • containment of hip
        • improve range of motion, bracing, proximal femoral osteotomy, pelvic osteotomy
          • ensure that femoral head is well seated in acetabulum
    • Nonoperative
      • observation alone, activity restriction (non-weightbearing), and physical therapy (ROM exercises)
        • indications
          • children < 8 years of age (bone age <6 years)
            • young patients typically do not benefit from surgery
          • lateral pillar A involvement
        • technique
          • activity restriction and protected weight-bearing during earlier stages until reossification is complete
          • main goals of treatment are to keep the femoral head contained and maintain good motion
            • containment limits deformity and minimizes loss of sphericity
              • lessen subsequent degenerative changes
          • bracing and casting for containment have not been found to be beneficial in a large, prospective study
          • all patients require periodic clinical and radiographic followup until completion of disease process
        • outcomes
          • good outcomes correlate with a spherical femoral head
            • 60% do not require operative intervention
            • good outcomes associated with lateral pillar A and Catterall I groups
    • Operative
      • femoral and/or pelvic osteotomy
        • indications
          • children > 8 years of age, especially lateral pillar B and B/C
        • technique
          • proximal femoral varus osteotomy
            • to provide containment
          • pelvic osteotomy
            • Salter or triple innominate osteotomy
            • Shelf arthroplasty may be performed to prevent lateral subluxation and resultant lateral epiphyseal overgrowth
        • outcomes
          • children with lateral pillar A and those with B under 8 years did well regardless of treatment
          • large recent studies show improved outcomes with surgery for lateral pillar B and B/C in children > 8 years (bone age >6 years)
          • studies sugggest earlier surgery before femoral head deformity develops may be best
          • poor outcome for lateral pillar C regardless of treatment
      • valgus and/or shelf osteotomies
        • indications
          • hinge abduction
            • lateral extrusion of the capital femoral epiphysis producing a painful hinge effect on the lateral acetabulum during abduction
        • abduction-extension osteotomy
          • reposition the hinge segment away from the acetabular margin
          • correct shortening from fixed adduction
          • improve abductor mechanism by improving abductor muscle contractile length
        • Shelf or Chiari osteotomies are also considered when the femoral head is no longer containable
      • hip arthroscopy
        • emerging treatment modality for mechanical abnormalities in the setting of healed LCPD
          • femoroacetabular impingement
      • hip arthrodiastasis
        • indications
          • controversial indications and outcomes
        • technique
          • hip distraction via external fixation
  • Technique
  • Complications
  • Prognosis
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1 of 10
Pediatrics | Legg-Calve-Perthes Disease (ft. Dr. Rachel Goldstein)
  • Pediatrics
  • - Legg-Calve-Perthes Disease
11:11 min
10/18/2019
625 plays
5.0
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(2)
Pediatrics | Legg-Calve-Perthes Disease
  • Pediatrics
  • - Legg-Calve-Perthes Disease
24:57 min
3/27/2020
3499 plays
4.6
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(13)
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