Legg-Calve-Perthes disease

Case contributed by Dr Erik Ranschaert


Persistent pain in the right hip. Ultrasound did not show any signs of synovitis. Follow-up plain radiograph of bilateral hips performed.

Patient Data

Age: 5 years
Gender: Female

Both femoral epiphyses show extensive destruction, the acetabula are deformed.

Case Discussion

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, 1 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 complaints 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. Revascularization 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 the 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.​

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Case information

rID: 10654
Published: 1st Sep 2010
Last edited: 29th Sep 2020
Tag: hip
Inclusion in quiz mode: Included

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