Legg-Calvé-Perthes Disease
Legg-Calvé-Perthes disease (LCPD) is a pediatric idiopathic osteonecrosis (avascular necrosis) of the capital femoral epiphysis, resulting from a temporary disruption of blood supply. This leads to ischemic necrosis of the femoral head, causing collapse, deformation, and subsequent remodeling over time. It primarily affects children between 4 and 10 years of age with a slight male predominance and can result in permanent hip deformity and early osteoarthritis if left untreated or poorly managed. Understanding the pathophysiology, clinical presentation, and management options is essential to optimize outcomes and prevent long-term disability.
Anatomy and Biomechanics
Proximal Femur Anatomy: The proximal femur consists of the femoral head (epiphysis), neck (metaphysis), and greater and lesser trochanters (apophyses). The capital femoral epiphysis in children is separated from the neck by the physis (growth plate). The spheroid femoral head articulates congruently within the acetabulum, forming the hip joint supported by labrum and capsuloligamentous structures.
Blood Supply: The vascularization of the femoral head is critical and complex:
- The primary blood supply to the epiphysis is via the lateral epiphyseal artery, which branches from the medial femoral circumflex artery and enters posteriorly along the femoral neck via the retinacular vessels.
- Secondary blood supply stems from the artery…