Legg-Calvé-Perthes Disease Presenting With Limp and Knee Pain

A 10-year-old boy presented with right hip pain and a limp. The patient was taking no medications and had no personal or family history of disease. He denied a history of trauma.

Examination revealed decreased abduction and internal rotation of the right hip and pain with movement. The differential diagnosis included fracture, osteomyelitis, hip dislocation, and avascular necrosis of the femoral head.

Anteroposterior radiographs of the pelvis revealed a metaphyseal lucency and a broad, short femoral neck on the right side. There is irregularity and collapse of the epiphysis with flattening, sclerosis, and distortion of the articular surface.

Daniel S. Case, BS, and Mitch Kok, MD, of Kansas City, Mo, comment that these findings are consistent with idiopathic necrosis of the femoral head-Legg-Calv-Perthes disease. This condition is most commonly seen in boys between ages 4 and 12 years; it is uncommon among African American children. The condition is usually unilateral; hip pain and a limp are typical presenting symptoms. Decreased range of motion is also typical-especially with abduction and internal rotation.

The prognosis is more favorable with early age at onset of disease and worse with increasing involvement of the femoral head. Recovery may be complete or can result in eventual degenerative arthritis. Complications include osteoarthritis, osteochondritis dissecans, and infection in patients with sickle cell anemia.¹ Treatment options include bed rest and traction or surgical containment. This patient was referred to an orthopedic clinic for surgical containment.

REFERENCE:1. Herring JA. Tachdjian's Pediatric Orthopaedics. 3rd ed. Philadelphia: WB Saunders Company; 2002:655-709.