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Legg-Calvé-Perthes Disease
Brady K. Huang, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Legg-Calvé-Perthes (LCP)
        • Synonyms

          • Perthes, avascular or ischemic necrosis of proximal femoral epiphysis, Legg-Perthes disease, osteochondritis coxae juvenilis, coxa plana
        • Definitions

          • Childhood idiopathic osteonecrosis (ON) of femoral head

        IMAGING

        • General Features

          • Radiographic Findings

            • MR Findings

              • Nuclear Medicine Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Maleki A et al: Surgical treatments for Legg-Calvé-Perthes disease: comprehensive review. Interact J Med Res. 10(2):e27075, 2021
                                      2. Schroeder PB et al: Hip injuries in the adolescent athlete. Clin Sports Med. 40(2):385-98, 2021
                                      3. Schlung J et al: Top ten adult manifestations of childhood hip disorders: an up-to-date review for general radiologists. Radiol Clin North Am. 58(3):529-48, 2020
                                      4. Ibrahim T et al: The pathogenesis and treatment of Legg-Calvé-Perthes disease. JBJS Rev. 4(7), 2016
                                      5. Heesakkers N et al: The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty one years. Int Orthop. 39(5):859-63, 2015
                                      6. Siebenrock KA et al: Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 473(4):1274-83, 2015
                                      7. Accadbled F et al: "Femoroacetabular impingement". Legg-Calve-Perthes disease: from childhood to adulthood. Orthop Traumatol Surg Res. 100(6):647-9, 2014
                                      8. Cook PC: Transient synovitis, septic hip, and Legg-Calvé-Perthes disease: an approach to the correct diagnosis. Pediatr Clin North Am. 61(6):1109-18, 2014
                                      9. Kim HK et al: Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement: a preliminary study. J Bone Joint Surg Am. 96(14):1152-60, 2014
                                      10. Palmen NK et al: Post-operative quality of life in children with severe perthes disease: differences to matched controls and correlation with clinical function. Orthop Rev (Pavia). 6(4):5567, 2014
                                      11. Vijayan S et al: The fate of the joint space in Legg-Calvé-Perthes' disease. Skeletal Radiol. 42(3):341-5, 2013
                                      12. Zucker EJ et al: Hip disorders in children. AJR Am J Roentgenol. 201(6):W776-96, 2013
                                      13. Chang JH et al: Outcomes in advanced Legg-Calvé-Perthes disease treated with the Staheli procedure. J Surg Res. 168(2):237-42, 2011
                                      14. Kim HK: Legg-Calve-Perthes disease: etiology, pathogenesis, and biology. J Pediatr Orthop. 31(2 Suppl):S141-6, 2011
                                      15. Kim HK: Legg-Calvé-Perthes disease. J Am Acad Orthop Surg. 18(11):676-86, 2010
                                      16. Merlini L et al: Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol. 40(3):318-25, 2010
                                      17. Vosmaer A et al: Coagulation abnormalities in Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 92(1):121-8, 2010
                                      18. Zilkens C et al: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in the long-term follow-up after Perthes disease. J Pediatr Orthop. 30(2):147-53, 2010
                                      19. Dillman JR et al: MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol. 193(5):1394-407, 2009
                                      20. Lee DS et al: Prognostic value of modified lateral pillar classification in Legg-Calvé-Perthes disease. Clin Orthop Surg. 1(4):222-9, 2009
                                      21. Zilkens C et al: Clinical presentation of young adults after Legg-Calvé-Perthes disease. Acta Orthop Belg. 75(6):754-60, 2009
                                      22. Cho TJ et al: Femoral head deformity in Catterall groups III and IV Legg-Calvé-Perthes disease: magnetic resonance image analysis in coronal and sagittal planes. J Pediatr Orthop. 22(5):601-6, 2002
                                      23. Fitzgerald RH et al: Orthopaedics. Legg-Calvé-Perthes. Mosby. Sect 9 (9-19):1420-32, 2002
                                      24. de Sanctis N et al: Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part I: the role of physeal involvement. J Pediatr Orthop. 20(4):455-62, 2000
                                      25. de Sanctis N et al: Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part II: pathomorphogenesis and new classification. J Pediatr Orthop. 20(4):463-70, 2000
                                      26. Gabriel H et al: MR imaging of hip disorders. Radiographics. 14(4):763-81, 1994
                                      27. Herring JA et al: The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 12(2):143-50, 1992
                                      28. Bos CF et al: Sequential magnetic resonance imaging in Perthes' disease. J Bone Joint Surg Br. 73(2):219-24, 1991
                                      29. Egund N et al: Legg-Calvé-Perthes disease: imaging with MR. Radiology. 179(1):89-92, 1991
                                      30. Rush BH et al: Legg-Calvé-Perthes disease: detection of cartilaginous and synovial change with MR imaging. Radiology. 167(2):473-6, 1988
                                      31. Thompson GH et al: Legg-Calvé-Perthes disease. Current concepts and controversies. Orthop Clin North Am. 18(4):617-35, 1987
                                      32. Toby EB et al: Magnetic resonance imaging of pediatric hip disease. J Pediatr Orthop. 5(6):665-71, 1985
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Clinical Issues

                                            TERMINOLOGY

                                            • Abbreviations

                                              • Legg-Calvé-Perthes (LCP)
                                            • Synonyms

                                              • Perthes, avascular or ischemic necrosis of proximal femoral epiphysis, Legg-Perthes disease, osteochondritis coxae juvenilis, coxa plana
                                            • Definitions

                                              • Childhood idiopathic osteonecrosis (ON) of femoral head

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • MR Findings

                                                  • Nuclear Medicine Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            • Gross Pathologic & Surgical Features

                                                              • Microscopic Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Maleki A et al: Surgical treatments for Legg-Calvé-Perthes disease: comprehensive review. Interact J Med Res. 10(2):e27075, 2021
                                                                          2. Schroeder PB et al: Hip injuries in the adolescent athlete. Clin Sports Med. 40(2):385-98, 2021
                                                                          3. Schlung J et al: Top ten adult manifestations of childhood hip disorders: an up-to-date review for general radiologists. Radiol Clin North Am. 58(3):529-48, 2020
                                                                          4. Ibrahim T et al: The pathogenesis and treatment of Legg-Calvé-Perthes disease. JBJS Rev. 4(7), 2016
                                                                          5. Heesakkers N et al: The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty one years. Int Orthop. 39(5):859-63, 2015
                                                                          6. Siebenrock KA et al: Head reduction osteotomy with additional containment surgery improves sphericity and containment and reduces pain in Legg-Calvé-Perthes disease. Clin Orthop Relat Res. 473(4):1274-83, 2015
                                                                          7. Accadbled F et al: "Femoroacetabular impingement". Legg-Calve-Perthes disease: from childhood to adulthood. Orthop Traumatol Surg Res. 100(6):647-9, 2014
                                                                          8. Cook PC: Transient synovitis, septic hip, and Legg-Calvé-Perthes disease: an approach to the correct diagnosis. Pediatr Clin North Am. 61(6):1109-18, 2014
                                                                          9. Kim HK et al: Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement: a preliminary study. J Bone Joint Surg Am. 96(14):1152-60, 2014
                                                                          10. Palmen NK et al: Post-operative quality of life in children with severe perthes disease: differences to matched controls and correlation with clinical function. Orthop Rev (Pavia). 6(4):5567, 2014
                                                                          11. Vijayan S et al: The fate of the joint space in Legg-Calvé-Perthes' disease. Skeletal Radiol. 42(3):341-5, 2013
                                                                          12. Zucker EJ et al: Hip disorders in children. AJR Am J Roentgenol. 201(6):W776-96, 2013
                                                                          13. Chang JH et al: Outcomes in advanced Legg-Calvé-Perthes disease treated with the Staheli procedure. J Surg Res. 168(2):237-42, 2011
                                                                          14. Kim HK: Legg-Calve-Perthes disease: etiology, pathogenesis, and biology. J Pediatr Orthop. 31(2 Suppl):S141-6, 2011
                                                                          15. Kim HK: Legg-Calvé-Perthes disease. J Am Acad Orthop Surg. 18(11):676-86, 2010
                                                                          16. Merlini L et al: Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol. 40(3):318-25, 2010
                                                                          17. Vosmaer A et al: Coagulation abnormalities in Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 92(1):121-8, 2010
                                                                          18. Zilkens C et al: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in the long-term follow-up after Perthes disease. J Pediatr Orthop. 30(2):147-53, 2010
                                                                          19. Dillman JR et al: MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol. 193(5):1394-407, 2009
                                                                          20. Lee DS et al: Prognostic value of modified lateral pillar classification in Legg-Calvé-Perthes disease. Clin Orthop Surg. 1(4):222-9, 2009
                                                                          21. Zilkens C et al: Clinical presentation of young adults after Legg-Calvé-Perthes disease. Acta Orthop Belg. 75(6):754-60, 2009
                                                                          22. Cho TJ et al: Femoral head deformity in Catterall groups III and IV Legg-Calvé-Perthes disease: magnetic resonance image analysis in coronal and sagittal planes. J Pediatr Orthop. 22(5):601-6, 2002
                                                                          23. Fitzgerald RH et al: Orthopaedics. Legg-Calvé-Perthes. Mosby. Sect 9 (9-19):1420-32, 2002
                                                                          24. de Sanctis N et al: Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part I: the role of physeal involvement. J Pediatr Orthop. 20(4):455-62, 2000
                                                                          25. de Sanctis N et al: Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part II: pathomorphogenesis and new classification. J Pediatr Orthop. 20(4):463-70, 2000
                                                                          26. Gabriel H et al: MR imaging of hip disorders. Radiographics. 14(4):763-81, 1994
                                                                          27. Herring JA et al: The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 12(2):143-50, 1992
                                                                          28. Bos CF et al: Sequential magnetic resonance imaging in Perthes' disease. J Bone Joint Surg Br. 73(2):219-24, 1991
                                                                          29. Egund N et al: Legg-Calvé-Perthes disease: imaging with MR. Radiology. 179(1):89-92, 1991
                                                                          30. Rush BH et al: Legg-Calvé-Perthes disease: detection of cartilaginous and synovial change with MR imaging. Radiology. 167(2):473-6, 1988
                                                                          31. Thompson GH et al: Legg-Calvé-Perthes disease. Current concepts and controversies. Orthop Clin North Am. 18(4):617-35, 1987
                                                                          32. Toby EB et al: Magnetic resonance imaging of pediatric hip disease. J Pediatr Orthop. 5(6):665-71, 1985