Legg-Calvé-Perthes disease
Description
Ischemic necrosis that leads to eventual flattening of the head of the femur due to vascular interruption
Typically unilateral, occurring bilaterally in 20% of patients
Usually runs its course in 3 to 4 years
Occurs most commonly in boys ages 4 to 10
Tends to occur in families
May lead to premature osteoarthritis later in life from misalignment of the acetabulum and flattening of the femoral head
Also called coxa plana
Pathophysiology
Occurs in four stages:
The first stage, synovitis, is characterized by synovial inflammation and increased joint fluid. It typically lasts 1 to 3 weeks.
In the second (avascular) stage, vascular interruption causes necrosis of the ossification center of the femoral head (usually in several months to 1 year).
In the third stage, revascularization, new blood supply causes bone resorption and deposition of immature bone cells; new bone replaces necrotic bone and the femoral head gradually reforms.
The final, or residual stage, involves healing and regeneration; immature bone cells are replaced with normal bone cells, thereby fixing the joint’s shape (there may be residual deformity, based on the degree of necrosis that occurred in the second stage).
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