Legg-Calvé-Perthes disease is an osteochondrosis that involves idiopathic aseptic necrosis of the femoral capital epiphysis. Diagnosis is primarily based on history and physical examination findings, but radiographs are usually done. Treatment includes bed rest and immobilization.
Legg-Calvé-Perthes disease incidence is highest in children ages 5 to 10 years, and the disease is more common among boys. The disease is usually unilateral; bilateral involvement is seen in approximately 10% of cases. Prevalence varies by geography and patient population, affecting up to 29/100,000 children under age 15, with the highest prevalence in White children (1). Approximately 10% of cases are familial, but contributing genetic factors have not been definitively identified.
Characteristic symptoms of Legg-Calvé-Perthes disease are pain in the hip joint and gait disturbance (eg, limping); some children also have pain in the knee. Onset is gradual, and progression is slow. Joint movements may be limited, and thigh muscles may become wasted.
General reference
1. MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2020 Jun 24]. Legg-Calvé-Perthes disease; [updated 2024 Dec 9; cited 2025 Jun 9].
Diagnosis of Legg-Calvé-Perthes Disease
Primarily history and physical examination
Usually radiographs
Sometimes MRI
The diagnosis of Legg-Calvé-Perthes disease is suspected based on symptoms.
Radiographs are usually obtained and, if needed, an MRI is done to confirm the diagnosis and extent of the lesion. Radiographs may not initially be diagnostic because they can be normal or show minimal flattening. Radiographs done later in the course of the disease can show fragmentation of the femoral head, which contains areas of lucency and sclerosis.
In bilateral or familial cases, a radiographic skeletal survey to exclude hereditary skeletal disorders, particularly multiple epiphyseal dysplasia, is mandatory because prognosis and optimal management differ. Hypothyroidism, sickle cell anemia, chronic glucocorticoid use, and trauma must also be excluded.
Treatment of Legg-Calvé-Perthes Disease
Rest and immobilization
Sometimes surgery
Management of Legg-Calvé-Perthes disease is aimed at preserving the sphericity of the femoral head and maintaining hip joint function. Orthopedic treatment of the disease includes prolonged bed rest, mobile traction, slings, and abduction plaster casts and splints to contain the femoral head.
If a child is over 6 years of age and has moderate or severe bone destruction, surgery may be helpful. Some experts advocate subtrochanteric osteotomy with internal fixation followed by early ambulation.
Bisphosphonates have been effective in initial trials, but further studies are needed (1).
Treatment reference
1. Kumar V, Ali S, Verma V, Singh A. Do bisphosphonates alter the clinico-radiological profile of children with Perthes disease? A systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2021;25(15):4875-4894. doi:10.26355/eurrev_202108_26445
Prognosis for Legg-Calvé-Perthes Disease
Without treatment, the course is usually prolonged but self-limited (usually 2 to 3 years). When the disease eventually becomes quiescent, residual distortion of the femoral head and acetabulum predisposes to secondary degenerative osteoarthritis.
With treatment, sequelae are less severe. Children who are < 8 years of age and children with less femoral head destruction (ie, when the height of the lateral pillar is > 50%) when diagnosed have the best outcome (1).
Prognosis reference
1. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg Am. 2004;86(10):2121-2134.
