From the Research
Legg-Calvé-Perthes disease typically presents in children aged 4-10 years with a gradual onset of hip pain, limping, and limited hip movement. The classic presentation includes pain that may be referred to the thigh or knee, a painless limp that worsens with activity, and decreased internal rotation and abduction of the affected hip. Physical examination reveals limited range of motion, particularly in abduction and internal rotation, with possible thigh muscle atrophy and leg length discrepancy. Children may demonstrate an antalgic gait, walking with a limp to minimize weight-bearing on the affected side. The condition is more common in boys than girls (4:1 ratio) and is usually unilateral, though bilateral involvement occurs in about 10-15% of cases. Symptoms often worsen with activity and improve with rest. The underlying pathophysiology involves temporary interruption of blood supply to the femoral head, leading to avascular necrosis, subsequent collapse, and eventual remodeling of the femoral head. Early diagnosis is crucial for optimal outcomes, as younger children have greater remodeling potential. Radiographs may initially be normal but later show increased density of the femoral head, fragmentation, flattening, and eventual healing with residual deformity depending on disease severity, as noted in a study published in Der Orthopade 1.
Some key points to consider in the presentation of Perthes disease include:
- The importance of early diagnosis for optimal outcomes, as highlighted in a study published in Clinical orthopaedics and related research 2
- The use of X-ray imaging as the method of choice for diagnostics and follow-up examination, as stated in a study published in Der Orthopade 1
- The potential benefits of advanced MRI imaging in detecting patients at risk earlier than conventional X-ray imaging, as mentioned in a study published in Der Orthopade 1
- The role of non-operative treatment, such as improving hip range of motion and unloading, as well as analgesic and/or anti-inflammatory medication, according to symptoms or findings, as discussed in a study published in Der Orthopade 1
- The indication for surgery in cases of loss of containment, especially in children older than 6 years, as noted in a study published in Der Orthopade 1.
It is essential to prioritize the most recent and highest quality study, which in this case is the study published in Der Orthopade 1, to guide the diagnosis and treatment of Perthes disease.