Pediatric emergency medicine trisk 3970 3970
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LEGG–CALVé–PERTHES DISEASE
Current Evidence
LCPD is a hip disorder that affects about 1 in 1,200 children and generally has
onset between the ages of 4 and 9 years. Males outnumber females by a ratio of
4:1. Most children with LCPD are short, often obese, and may have delayed
skeletal maturation.
There is no clear consensus on the etiology of LCPD, or osteonecrosis of the
capital femoral epiphysis. Mechanical factors inducing ischemia and avascular
necrosis is one prominent hypothesis. Twin studies do not support an important
genetic role but there is evidence for environmental factors in the development of
LCPD.
Clinical Considerations
Clinical Recognition
Patients may remain asymptomatic despite varying degrees of necrosis and
resorption of the femoral head. Some children recover completely without
developing symptoms. Symptoms usually begin when routine trauma causes
stress fracture of the abnormal subchondral bone. Rarefaction (i.e., reduced
density) of the femoral head with subluxation and deformity may ensue. The
process of reossification and remodeling takes 2 to 4 years.
