Legg-Calve-Perthes disease

Definitions & Key takeaways

Legg �Calv� �Perthes disease (LCPD) refers to a childhood hip disorder that occurs when the blood supply to the head of femur is disrupted for unknown reasons, resulting in avascular necrosis of the head of femur. The disease was named after three doctors; Arthur Legg, Jacques Calv�, and Georg Perthes. Children with LCPD develop hip limping and pain which worsens with activity, and it may be referred to the knee. The condition is often treated with surgery and physiotherapy to help restore movement and function.

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Introduction0:00–0:20

Legg–Calvé–Perthes disease is a childhood hip disorder that occurs when the blood supply to the head of femur gets disrupted and leads to death or necrosis of the tissue.
The disease was named after three doctors; Arthur Legg, Jacques Calvé, and Georg Perthes. The hip joint is a ball and socket type, because the ball-shaped head of femur sits and rotates inside the cup-shaped socket called the acetabulum.

Physiology0:20–0:56

This gives the hip joint the ability to move nearly in all directions, as long as the ball can smoothly rotate inside the socket.
Now, the head of femur is supplied by branches of 3 arteries, the medial and lateral femoral circumflex arteries, as well as the artery of ligamentum teres.
The arteries send branches that climb up the neck of the femur to supply the head of the femur, providing the tissue with the nutrition it needs to grow and maintain its spherical shape.

Pathology0:56–2:02

In Legg–Calvé–Perthes disease, for some children, the blood supply to the femoral head becomes interrupted for some reason - and it’s not known why exactly.
The result is that the tissue begins to die off - a process called avascular necrosis. Over time, there’s new blood vessel formation into the necrotized bone and that allows the dead tissue to get removed by immune cells called macrophages.
That process causes the head of femur to lose mass, leaving it weak and prone to fractures. When this happens, the head of femur becomes misshapen and can no longer smoothly rotate inside the concave acetabulum, which results in reduced range of motion.
Now, over time, Legg–Calvé–Perthes disease typically self-resolves and the bone is able to heal - once again it’s not known exactly why or how this happens.
When bone remodeling occurs, new bone replaces the necrosed bone, and the spherical shape of the head of femur gets restored and properly fits in the acetabulum again.
With time, there’s normal functioning of the joint once more. Children with Legg–Calvé–Perthes disease develop a limp and hip pain which is sometimes referred to the knee.

Symptoms2:02–2:33

The pain usually gets worse with activity, which may even make the affected hip very difficult to move. This particularly affects abduction – moving the leg laterally away from your body, as well as internal rotation – which is turning your leg inward.
Also, because the affected leg is less used, its muscles may become atrophied, causing the leg to look smaller than the normal one.

Diagnosis2:33–2:49

Diagnosis of Legg–Calvé–Perthes disease mainly involves taking X-rays of the hip which reveal a flattened and misshapen femoral head.
In addition, an MRI can be done to see the shape of the bone as well as look for the formation of new blood vessels. Legg–Calvé–Perthes disease can sometimes resolve by itself over time, so treatment is mainly conservative involving rest, pain management, and physical therapy to preserve joint mobility.

Treatment2:49–3:11

If the head of femur is very fractured, surgery may be needed to affix braces and abduct the head of femur, to maintain its spherical shape as it regenerates.

Review3:11–3:48

Alright, as a quick recap, … Legg–Calvé–Perthes disease refers to a childhood hip disorder which occurs when the blood supply to the head of femur is disrupted for unknown reasons, resulting in avascular necrosis of the head of femur.
Children have hip limping and pain which worsens with activity, and it may be referred to the knee. The diagnosis of this disease is mainly done with X-rays and MRI of the limping hip.
Its treatment consists of resting the sick hip, having some physical therapy, and managing the pain, but also the hip surgery may be indicated