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Staging of Legg-Calvé-Perthes disease

Dr Jeremy Jones and Dr Frank Gaillard et al.

Staging of Legg-Calve-Perthes syndrome refers to x-ray abnormalities, and represents 4 phases of the disease :

stage I : early
- asymmetric femoral epiphyseal size (smaller on affected side)
- apparent increased density of the femoral head epiphysis
- widening of the medial joint space
- blurring of the physeal plate
- radiolucency of the proximal metaphysis
stage II : fragmentation
- subchondral lucency (crescent sign)
- femoral epiphysis fragments
- femoral head outline is difficult to make out
- mottled density
- thickened trabeculae
stage III : reparative
- re-ossification begins
- shape of the femoral head becomes better defined
- bone density begins to return
stage IV : healed
- changes depend on severity the femoral head may be nearly normal or may demonstrate
- flattening of the articular surface, especially superiorly
- widening of the head and neck of the femur