a 5-year old girl presented for ultrasound examination of the hips due to persisting pain in the right hip. The ultrasound did not show any signs of synovitis, the radiologists asked for an additional plain film of both hips.
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Both femoral epiphyses show extensive destruction, the acetabula are deformed.
Legg-Calve-Perthes disease (LCPD) is the name given to idiopathic osteonecrosis or avascular necrosis of the capital femoral epiphysis of the femoral head. In 15-20% of patients with LCPD involvement is bilateral. in the US one in 1200 children younger than 15 years is affected by LCPD.
- the disease is most commonly seen at the age of 4-8 years.
- Males are affected 4-5 times more often than females.
- Caucasians are affected more frequently than persons of other races.
Symptoms of LCPD usually are present for several weeks or longer before the disease is detected. Often the child does not complain. Typical complants are hip or groin pain, limping, no history of trauma.
Etiology of LCPD is unclear, it is accepted that the blood supply to the capital femoral epiphysis is interrupted causing bone infarction. Revascularisation starts and subsequently new bone formation is started. At this point a percentage of patients develops LCPD.
The Catterall classification is based on radiographic appearances and is as follows:
- Stage I: histologic and clinical diagnosis without radiographic findings
- Stage II: sclerosis with or without cystic changes with preservation of the contour and surface of femoral head
- Stage III: loss of structural integrity of the epiphysis
- Stage IV: loss of structural integrity of the acetabulum in addition
The Salter-Thomson classification reduces the Catterall groups to 2:
- Group A includes Catterall groups I and II. Less than 50% of the head is involved in this group.
- Group B includes Catterall groups III and IV and more than 50% of the epiphysis is involved.
The prognosis is potentially poor for the latter group.