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242: LEGG–CALVÉ–PERTHES DISEASE

Kay Tasso, PhD, PT, PCS

CONDITION/DISORDER SYNONYMS

  • Juvenile osteochondrosis of hip and pelvis

  • Avascular necrosis of the proximal femur

  • Coxa plana

ICD-9-CM CODE

  • 732.1 Juvenile osteochondrosis of hip and pelvis

ICD-10-CM CODE

  • M91.1 Juvenile osteochondrosis of head of femur

PREFERRED PRACTICE PATTERN

  • 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion (ROM) Associated with Bony or Soft Tissue Surgery1

PATIENT PRESENTATION

An 11-year-old male is referred to physical therapy with a diagnosis of Legg–Calvé–Perthes disease (LCPD). Gait analysis reveals an antalgic gait on the affected side. The child reports 7/10 pain in the hip and groin and difficulty with ambulation and stair climbing. His passive range of motion (RON) is limited in hip internal rotation, abduction, and extension. The parents report use of a Scottish-Rite brace was unsuccessful and the child is scheduled for surgical correction. The therapist instructs the child in crutch training pre-op and then provides gait training, RMO exercises, and strengthening post-op.

KEY FEATURES

Description

  • Impairment of blood flow to the hip resulting in destructive changes

  • Self-limiting disease of the hip

Essentials of Diagnosis

  • Age of onset or detection is best predictor of successful recovery

General Considerations

  • Four stages

    • Stage 1. Condensation: bone stops and femoral head becomes necrotic

    • Stage 2. Fragmentation of necrotic bone; femoral head and acetabulum become deformed; revascularization begins

    • Stage 3. Reossification of femoral head

    • Stage 4. Remodeling of femoral head and acetabulum

FIGURE 242-1

Legg–Calvé–Perthes disease. Chronic and significant deformity of the left femoral head is apparent (arrow). Subcortical cysts are also present. The joint space is normal. (Reproduced with permission from Shah BR, Lucchesi M: Atlas of Pediatric Emergency Medicine, © 2006, McGraw-Hill, New York.)

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Demographics

  • Children aged 3 to 13 years old, especially males aged 5 to 7 years old

  • Males 3 to 5 times more likely than females

  • Usually unilateral; bilateral 10% to20% of the time

  • Uncommon in African Americans

FIGURE 242-2

Legg–Calvé–Perthes disease is present bilaterally. (From Simon RR, Sherman SC Emergency Orthopedics. 6th edition. www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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TABLE 242-1Differentiation of Pediatric Hip Pathologies
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TABLE 242-1 Differentiation of Pediatric Hip Pathologies
Congenital Hip Dislocation Septic Arthritis Legg–Calvé–Perthes Disease Transient Synovitis Slipped Femoral Capital Epiphysis
Age Birth Less than 2 years; rare in adults 2–13 years 2–12 years Males: 10–17 years; females: 8–15 years
Incidence Female > male; left ...

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