Materiały źródłowe

• #1 Legg-Calve-Perthes Disease: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/826935-overview

  Legg-Calv-Perthes disease (LCPD) is avascular necrosis (AVN) of the proximal femoral head resulting from compromise of the tenuous blood supply to this area. LCPD usually occurs in children aged 4-10 years. The earliest sign of is an intermittent limp (abductor lurch), especially after exertion, with mild or intermittent pain in the anterior part of the thigh. Hip pain may develop and is a result of necrosis of the involved bone. Pain may be present with passive range of motion (ROM) and limited hip movement, especially internal rotation and abduction. […] Initial therapy includes minimal weightbearing and protection of the joint. […] Results of surgical containment appear to be better than those of nonsurgical containment (orthosis). Surgical management typically involves either femoral osteotomy to redirect the involved portion within the acetabulum or innominate osteotomy.

• #2 Legg–Calvé–Perthes disease – Wikipedia

  https://en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_disease

  X-rays of the hip may suggest and/or verify the diagnosis. X-rays usually demonstrate a flattened, and later fragmented, femoral head. A bone scan or MRI may be useful in making the diagnosis in those cases where X-rays are inconclusive. Usually, plain radiographic changes are delayed six weeks or more from clinical onset, so bone scintigraphy and MRI are done for early diagnosis. MRI results are more accurate, i.e. 97-99% against 88-93% in plain radiography. If MRI or bone scans are necessary, a positive diagnosis relies upon patchy areas of vascularity to the capital femoral epiphysis (the developing femoral head). […] Perthes is generally diagnosed between 5 and 12 years of age, although it has been diagnosed as early as 18 months. Typically, the disease is only seen in one hip, but bilateral Perthes is seen in about 10% of children diagnosed.

• #3 Legg-Calve-Perthes disease – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/legg-calve-perthes-disease/symptoms-causes/syc-20374343

  Legg-Calve-Perthes (LEG-kahl-VAY-PER-tuz) disease is a childhood condition that occurs when blood supply to the ball part (femoral head) of the hip joint is temporarily interrupted and the bone begins to die. […] Make an appointment with your healthcare professional if your child begins limping or complains of hip, groin or knee pain. […] The cause of the reduced blood flow is unknown. […] Children who have had Perthes disease are at higher risk of developing hip arthritis in adulthood especially if the hip joint has poor healing. […] In general, children who are diagnosed with Perthes disease after age 6 are more likely to develop hip conditions later in life.

• #4 Legg-Calvé-Perthes Disease: Diagnosis, Imaging, and Classifications | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-642-35767-1_60

  Legg-Calve-Perthes disease (LCPD) is a self-limited childhood hip disorder of unknown etiology that can produce permanent deformity of the femoral head. […] The diagnosis of LCPD requires plain radiography and careful history taking as its symptoms and physical findings are nonspecific and it is a diagnosis of exclusion. Other pediatric conditions that produce femoral head osteonecrosis or LCPD-like changes on radiography must be ruled out through history, physical examination, and radiographic assessment.

• #5 Legg–Calvé–Perthes disease overview | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-022-02275-z

  LeggCalvPerthes Disease (LCPD) is characterized by, unilateral or bilateral, necrosis of the femoral head (FH). Which affects the range of motion of the hip. […] Although LCPD was first described in the beginning of the past century and has been studied for more than 100 years, limited is known about its etiology. […] However, even though different diagnosis methods and treatments have been used throughout history, the etiology of LCPD remains unknown. […] Due to lack of information, LCPD diagnosis can be difficult; nevertheless, there are some important diagnostic criteria (Table 2). Differential diagnoses that must be considered given the radiographic findings include, coxitis fugax, Meyer dysplasia, epiphyseal dysplasia, spondyloepiphyseal dysplasia, chondroblastoma, juvenile idiopathic arthritis, drug-induced femoral head necrosis, Gauchers disease, sickle cell anemia, thalassemia, achondroplasia and Klinefelter syndrome.

• #6 Legg-Calve-Perthes Disease: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/826935-overview

  Legg-Calv-Perthes disease (LCPD) is avascular necrosis (AVN) of the proximal femoral head resulting from compromise of the tenuous blood supply to this area. LCPD usually occurs in children aged 4-10 years. The earliest sign of is an intermittent limp (abductor lurch), especially after exertion, with mild or intermittent pain in the anterior part of the thigh. Hip pain may develop and is a result of necrosis of the involved bone. Pain may be present with passive range of motion (ROM) and limited hip movement, especially internal rotation and abduction. […] Initial therapy includes minimal weightbearing and protection of the joint. […] Results of surgical containment appear to be better than those of nonsurgical containment (orthosis). Surgical management typically involves either femoral osteotomy to redirect the involved portion within the acetabulum or innominate osteotomy.

• #7 Legg-Calvé-Perthes disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/751

  Legg-Calv-Perthes disease is characterized by a phenotype of short stature, delayed bone age, and hyperactivity. […] Clinical features include a limping gait and hip pain frequently radiating into the thigh, knees, groin, or buttocks. Pain worsens during activities. […] Key diagnostic factors include limp and limited range of motion at the hip joint. […] Other diagnostic factors include short stature, muscle wasting, hyperactivity, Trendelenburg sign, asymmetric limb length, knee pain, thigh pain, groin/buttock pain, synovitis, and minor trauma. […] 1st tests to order include bilateral hip x-rays. […] Tests to consider include CBC, serum erythrocyte sedimentation rate, serum CRP, bone scintigraphy, and MRI of hips.

• #8 Legg-Calvé-Perthes Disease Treatment – Children’s Hospital of Orange County

  https://choc.org/orthopaedics/hip-program/legg-calve-perthes-disease/

  Legg-Calvés disease is a temporary condition in children in which the ball-shaped head of the thigh bone loses its blood supply. This causes the head of the bone to collapse. The body will absorb the dead bone cells and replace them with new bone cells, eventually reshaping the femoral head. Legg-Calvés disease causes the hip joint to become painful and stiff for a short period of time. […] The diagnosis of Legg-Calvés disease should be made as early as possible. […] Symptoms can include a child’s decreased mobility, pain or other complaints in the hip area. The child typically complains of pain in the hip that is made worse by activity. Sometimes, they will also experience pain in their thigh or knee area. Limping is often the earliest sign of Legg-Calvés disease. Pain or stiffness in the hip, groin or knee is possible as well. For some children, the affected leg becomes shorter due to bone collapse.

• #9 Legg–Calvé–Perthes disease overview | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-022-02275-z

  The identification of the phase is of utmost therapeutic importance. […] The main symptoms of LCPD are lameness and localized pain in the hip, radiating to the thigh and knee; nonetheless, some cases present painless limp. […] Most of these symptoms are linked to the loss of the hip joint axis. […] The choice of treatment is made based on the radiographic characteristics of the patient. […] The sequelae found in LCPD patients after the age of 40 are minimal, and the long-term prognosis tends to be good in 60% to 80% of the total cases. […] The cause of LCPD is unknown. Different etiologies have been proposed; nevertheless, LCPD may be caused by multiple etiologic factors that share a common final pathogenic pathway. […] A new perspective is that LCPD is a multifactorial disease caused by a combination of environmental, metabolic and genetic factors.

• #10 Legg–Calvé–Perthes disease overview | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-022-02275-z

  The identification of the phase is of utmost therapeutic importance. […] The main symptoms of LCPD are lameness and localized pain in the hip, radiating to the thigh and knee; nonetheless, some cases present painless limp. […] Most of these symptoms are linked to the loss of the hip joint axis. […] The choice of treatment is made based on the radiographic characteristics of the patient. […] The sequelae found in LCPD patients after the age of 40 are minimal, and the long-term prognosis tends to be good in 60% to 80% of the total cases. […] The cause of LCPD is unknown. Different etiologies have been proposed; nevertheless, LCPD may be caused by multiple etiologic factors that share a common final pathogenic pathway. […] A new perspective is that LCPD is a multifactorial disease caused by a combination of environmental, metabolic and genetic factors.

• #11 Legg-Calvé-Perthes Disease Treatment – Children’s Hospital of Orange County

  https://choc.org/orthopaedics/hip-program/legg-calve-perthes-disease/

  Diagnosis of Legg-Calvés disease is often based on a child’s signs and symptoms, a physical exam and imaging studies. The tests that a doctor may recommend include X-rays, magnetic resonance imaging (MRI) or bone scans to detect changes in the child’s bones. Sometimes Legg-Calvés disease is detected by accident during an X-ray done for other reasons.

• #12 Legg-Calve-Perthes disease

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20374324

  During the physical exam, your healthcare professional might move your child’s legs into various positions to check range of motion and see whether any of the positions cause pain. […] These types of tests, which are vital to the diagnosis of Perthes disease, might include: […] Initial X-rays may not show changes in the hip. It can take 1 to 2 months after symptoms begin for the changes related to Perthes disease to become clear on X-rays. Your healthcare professional will likely recommend several X-rays over time to track the progression of the disease. […] This technology uses radio waves and a strong magnetic field to make very detailed images of bone and soft tissue inside the body. MRIs often can visualize bone damage caused by Perthes disease more clearly than X-rays can, but MRI isn’t always needed.

• #13 Legg Calve Perthes Disease (LCP)

  https://www.nationwidechildrens.org/conditions/legg-calve-perthes-disease-lcp

  This disease is first diagnosed with an x-ray. The x-ray will show the condition of the femoral head and the stage of collapse the bone is in. Magnetic resonance imaging (MRI) and bone scans may be used to diagnose LCP and show your childs provider how much of the femoral head is involved. […] Your childs health care provider will conduct a physical exam along with x-rays. The physical exam consists of the provider assessing your childs hip range of motion. Typically, a child with LCP has a hard time moving the leg away from the body and twisting the leg toward the inside of the body. The provider will look to see if your childs leg lengths are equal. Your child will walk so their gait can be assessed for any type of limp or abnormality.

• #14 Diagnosing Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/diagnosis

  Orthopedic specialists at Hassenfeld Childrens Hospital at NYU Langone are experienced in diagnosing Legg-Calv-Perthes disease also called Perthes disease which occurs when the blood supply to the ball of the hip joint, also known as the femoral head, is temporarily interrupted. […] To make an accurate diagnosis, our orthopedic specialists perform a comprehensive physical exam and use imaging tests to assess a child’s bones and joints. […] Hip and pelvic X-rays provide pictures of the bones in a child’s hip and pelvis. These images allow doctors to see if the bones have become misshapen or misaligned. […] MRI uses magnetic fields and radio waves to produce detailed images of areas that are more difficult to see on X-rays, such as cartilage, ligaments, and blood vessels. MRI scans can detect problems within the hip joint before the femoral head becomes permanently misshapen.

• #15 Legg Calve Perthes Disease (LCP)

  https://www.nationwidechildrens.org/conditions/legg-calve-perthes-disease-lcp

  This disease is first diagnosed with an x-ray. The x-ray will show the condition of the femoral head and the stage of collapse the bone is in. Magnetic resonance imaging (MRI) and bone scans may be used to diagnose LCP and show your childs provider how much of the femoral head is involved. […] Your childs health care provider will conduct a physical exam along with x-rays. The physical exam consists of the provider assessing your childs hip range of motion. Typically, a child with LCP has a hard time moving the leg away from the body and twisting the leg toward the inside of the body. The provider will look to see if your childs leg lengths are equal. Your child will walk so their gait can be assessed for any type of limp or abnormality.

• #16 Legg Calve Perthes Disease – OrthoPaedia

  https://www.orthopaedia.com/legg-calve-perthes-disease/

  Legg-Calve-Perthes disease, commonly known as Perthes disease, is a hip disorder affecting children that is caused by decreased blood flow to the head of the femur. […] The definitive diagnosis of Perthes disease is made by x-ray. The disease is primarily classified by radiographic findings, using the Waldenstrom classification. The four stages of Perthes are denoted as initial, fragmentation, reossification, and healed. […] On x-ray, the femoral head is typically lateralized and more radiodense, and in later stages of disease the femoral head appears flattened. […] Another option for imaging is MRI, which has a higher diagnostic accuracy than x-ray, especially in the initial stage when radiographic findings may not be obvious. […] Laboratory findings are used in the diagnosis of Legg-Calve-Perthes disease primarily to rule out other diseases or illnesses. All laboratory values are typically within normal limits.

• #17 Legg-Calvé-Perthes Disease – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/bone-disorders-in-children/legg-calv%C3%A9-perthes-disease

  The diagnosis is based on x-rays and sometimes magnetic resonance imaging. […] The diagnosis of Legg-Calv-Perthes disease is confirmed by x-rays. An MRI is done if x-rays are normal or the doctor needs more information on the severity. Later x-rays may show changes around the growth plate, such as a fracture or destruction of the bone. […] Doctors take x-rays of the child’s skeleton if the disorder runs in the child’s family or both of the child’s legs are affected. These x-rays are taken to rule out hereditary disorders of the skeleton. […] Blood tests are done to rule out other disorders. Doctors try to determine whether the symptoms resulted from an injury.

• #18 Legg-Calve-Perthes Disease | PM&R KnowledgeNow

  https://now.aapmr.org/legg-calve-perthe-disease/

  When the diagnosis is unclear, initial laboratory studies can aid in ruling out other diagnoses. Complete blood count, erythrocyte sedimentation rate, and C-reactive protein may be helpful to rule out infection. These studies will be normal in LCPD. […] A detailed history should include the onset, duration, quality, location, radiation of pain, exacerbating or alleviating factors, and child’s activity level. […] Examine both lower extremities to identify bilateral LCPD. […] There are no established scales for functional assessment in LCPD. […] The Iowa Hip Score and Nonarthritic Hip Score are used in addition to the Stulberg classification to evaluate functional outcomes in LCPD.

• #19 Legg-Calve-Perthes Disease | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/legg-calve-perthes-disease

  How is Legg-Calve-Perthes disease diagnosed? […] In addition to a complete medical history and physical examination, diagnostic procedures for Perthes disease may include: […] X-ray for information about the structure of the femoral head […] MRI (magnetic resonance imaging) for information about the severity of the condition […] Blood tests to rule out infection or other conditions. […] Diagnosing and treating your childs Perthes disease early in its development greatly increases the likelihood of a successful outcome.

• #20 Legg-Calve-Perthes Disease | PM&R KnowledgeNow

  https://now.aapmr.org/legg-calve-perthe-disease/

  When the diagnosis is unclear, initial laboratory studies can aid in ruling out other diagnoses. Complete blood count, erythrocyte sedimentation rate, and C-reactive protein may be helpful to rule out infection. These studies will be normal in LCPD. […] A detailed history should include the onset, duration, quality, location, radiation of pain, exacerbating or alleviating factors, and child’s activity level. […] Examine both lower extremities to identify bilateral LCPD. […] There are no established scales for functional assessment in LCPD. […] The Iowa Hip Score and Nonarthritic Hip Score are used in addition to the Stulberg classification to evaluate functional outcomes in LCPD.

• #21 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease/

  Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the rounded head of the femur (thighbone) is temporarily disrupted. Without an adequate blood supply, the bone cells die, a process called avascular necrosis. […] X-rays, which provide pictures of dense structures like bone, are required to confirm a diagnosis of Perthes. X-rays will show the condition of the bone in the femoral head and help your child’s doctor determine the stage of the disease. […] A child with Perthes can expect to have several X-rays taken over the course of treatment, which may be 2 years or longer. As the condition progresses, X-rays often look worse before gradual improvement is seen.

• #22 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  Because the course of Legg-Calvé-Perthes disease (LCPD) is highly variable, its appropriate diagnostic evaluation and treatment are still debated. […] The diagnostic evaluation is performed in standard fashion with x-ray views in two planes. The pelvic survey film and lateral hip x-ray serve not only to establish the diagnosis, but also to enable classification, prognostic assessment, and follow-up of the course of the disease. […] Ultrasonography can be used as a supplementary technique to diagnose changes of the femoral head and, in particular, any accompanying synovitis or effusion. […] Magnetic resonance imaging (MRI) is of particular value in identifying the early stage of Perthes disease in the absence of changes on plain films, as well as in cases where the differential diagnosis would otherwise be difficult.

• #23 Legg-Calve-Perthes disease

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20374324

  During the physical exam, your healthcare professional might move your child’s legs into various positions to check range of motion and see whether any of the positions cause pain. […] These types of tests, which are vital to the diagnosis of Perthes disease, might include: […] Initial X-rays may not show changes in the hip. It can take 1 to 2 months after symptoms begin for the changes related to Perthes disease to become clear on X-rays. Your healthcare professional will likely recommend several X-rays over time to track the progression of the disease. […] This technology uses radio waves and a strong magnetic field to make very detailed images of bone and soft tissue inside the body. MRIs often can visualize bone damage caused by Perthes disease more clearly than X-rays can, but MRI isn’t always needed.

• #24 Perthes Disease – Legg-Calve-Perthes – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/perthes-disease

  Perthes disease is a rare childhood condition that affects the hip. […] X-rays, which provide pictures of dense structures like bone, are required to confirm a diagnosis of Perthes. […] A child with Perthes can expect to have several X-rays taken over the course of treatment, which may be 2 years or longer. […] Your child’s doctor may recommend surgery to re-establish the proper alignment of the bones of the hip and to keep the head of the femur deep within the acetabulum until healing is complete. […] The most common surgical procedure for treating Perthes disease is an osteotomy. In this type of procedure, the bone is cut and repositioned to keep the femoral head snugly within the acetabulum.

• #25 Legg Calve Perthes Disease – OrthoPaedia

  https://www.orthopaedia.com/legg-calve-perthes-disease/

  Legg-Calve-Perthes disease, commonly known as Perthes disease, is a hip disorder affecting children that is caused by decreased blood flow to the head of the femur. […] The definitive diagnosis of Perthes disease is made by x-ray. The disease is primarily classified by radiographic findings, using the Waldenstrom classification. The four stages of Perthes are denoted as initial, fragmentation, reossification, and healed. […] On x-ray, the femoral head is typically lateralized and more radiodense, and in later stages of disease the femoral head appears flattened. […] Another option for imaging is MRI, which has a higher diagnostic accuracy than x-ray, especially in the initial stage when radiographic findings may not be obvious. […] Laboratory findings are used in the diagnosis of Legg-Calve-Perthes disease primarily to rule out other diseases or illnesses. All laboratory values are typically within normal limits.

• #26

  https://journals.lww.com/jbjsjopa/fulltext/2024/09000/diagnosis_and_management_of_legg_calv__perthes.4.aspx

  Legg-Calv-Perthes disease (LCPD) is a condition marked by temporary blood flow disruption to the proximal femur, commonly afflicting children aged 15 years and younger. […] The etiology of the disease is often idiopathic and involves the development of avascular necrosis of the femoral head, subsequently leading to bone weakening and deformity. […] Treatment ranges from conservative measures to surgery, with particular challenges in obese patients. […] Plain film radiograph imaging using the anteroposterior pelvis and frog-leg lateral views is recommended if LCPD is suspected. […] Early findings of LCPD include joint space widening due to hypertrophy of the epiphyseal cartilage, a smaller and denser epiphysis, and a subchondral fracture of the anterolateral epiphysis in the setting of osteonecrosis (Crescent sign).

• #27 Legg-Calvé-Perthes disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/legg-calve-perthes-disease/

  Legg-Calv-Perthes disease (LCPD or Perthes disease) refers to an idiopathic, avascular necrosis of the femoral head. […] Early stages are only detectable on MRI but progress of the disease can be tracked and graded using conventional x-ray. […] Surgery is performed if x-ray reveals signs that indicate an unfavorable prognosis. […] The aim of surgical intervention is to cover the femoral head as completely as possible with the hip socket, thus retaining its anatomical position. […] Important prognostic factors include the age of onset and the extent of femoral head involvement. […] X-ray (anterior-posterior and frog leg positions) […] Frequently without pathological findings during early stages […] Increased lucency of the femoral head […] Flattening and fragmentation of the femoral head […] Joint space widening […] Head-at-risk signs: prognostically unfavorable radiographic signs (as defined by complementary Catterall classification) […] MRI: indicated if initial imaging is unremarkable but clinical suspicion persists.

• #28 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  The radiologically demonstrable stages that all children with Perthes disease pass through are based on the scheme devised by Waldenström. […] The most recent classification was proposed by Herring in 1992. It is based on the height of the lateral pillar of the epiphysis of the femoral head, as seen on an AP x-ray view in the early fragmentation phase. […] The predictive value of the Herring classification is higher when the patient’s age at the onset of the disease is also taken into account. […] The goal of all forms of treatment is to prevent deformity of the femoral head and incongruence of the affected hip. […] The extent of incongruence in adolescence determines the severity of the prearthrotic deformity, and thus also the probability of early secondary coxarthrosis. […] The type of treatment that is to be provided is determined on the basis of the radiological severity of the disease, the presence or absence of „head-at-risk signs,” the extent of limitation of mobility of the hip joint, and the age of the patient.

• #29

  https://journals.lww.com/jbjsjopa/fulltext/2024/09000/diagnosis_and_management_of_legg_calv__perthes.4.aspx

  Legg-Calv-Perthes disease is divided into 4 stages based on the Waldenstrom criteria: initial/necrosis (stage I), fragmentation (stage II), reossification (stage III), and healed/residual (stage IV). […] The Waldenstrom criteria are based on radiographic changes that occur as the disease progresses. […] Surgical interventions for LCPD include femoral osteotomy, salter osteotomy, and arthrodiastasis. […] Treatment modalities for LCPD range from self-management of the disease to surgical interventions. […] Providers should be aware of the atypical clinical presentation of LCPD in an obese child. […] Delayed diagnosis is directly correlated with increased morbidity and disability later in life.

• #30 Legg-Calve-Perthes disease

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20374324

  During the physical exam, your healthcare professional might move your child’s legs into various positions to check range of motion and see whether any of the positions cause pain. […] These types of tests, which are vital to the diagnosis of Perthes disease, might include: […] Initial X-rays may not show changes in the hip. It can take 1 to 2 months after symptoms begin for the changes related to Perthes disease to become clear on X-rays. Your healthcare professional will likely recommend several X-rays over time to track the progression of the disease. […] This technology uses radio waves and a strong magnetic field to make very detailed images of bone and soft tissue inside the body. MRIs often can visualize bone damage caused by Perthes disease more clearly than X-rays can, but MRI isn’t always needed.

• #31 Diagnosing Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/diagnosis

  Orthopedic specialists at Hassenfeld Childrens Hospital at NYU Langone are experienced in diagnosing Legg-Calv-Perthes disease also called Perthes disease which occurs when the blood supply to the ball of the hip joint, also known as the femoral head, is temporarily interrupted. […] To make an accurate diagnosis, our orthopedic specialists perform a comprehensive physical exam and use imaging tests to assess a child’s bones and joints. […] Hip and pelvic X-rays provide pictures of the bones in a child’s hip and pelvis. These images allow doctors to see if the bones have become misshapen or misaligned. […] MRI uses magnetic fields and radio waves to produce detailed images of areas that are more difficult to see on X-rays, such as cartilage, ligaments, and blood vessels. MRI scans can detect problems within the hip joint before the femoral head becomes permanently misshapen.

• #32 Perthes disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/perthes-disease?lang=us

  Perthes disease is a diagnosis of exclusion and other causes of osteonecrosis (including sickle cell disease, leukemia, corticosteroid administration, Gaucher disease) must be ruled out. […] The best initial test for the diagnosis of Perthes is a pelvic radiograph. In a small number of patients with Perthes, the radiograph will be normal and persistent symptoms will trigger further imaging, e.g. MRI. […] MRI is gaining an increasing role in a number of scenarios: early diagnosis, before the onset of x-ray findings; assessing the extent of cartilaginous involvement, important in prognosis; assessing joint congruence in a variety of joint positions (requires open magnet and dynamic imaging). […] Bone scintigraphy may show reduced uptake in the femoral head in the early stages of the disease, representing the reduced blood supply of osteonecrosis. In the later stages of the disease, there may be increased uptake reflecting a combination of repair of the femoral head and degenerative change in the femoral head and acetabulum.

• #33 Legg-Calvé-Perthes Disease: Diagnosis, Imaging, and Classifications | Radiology Key

  https://radiologykey.com/legg-calve-perthes-disease-diagnosis-imaging-and-classifications/

  Although radiography is useful in assessing disease progression, it lacks the sensitivity and specificity needed to demonstrate changes during the early stages of the disease. […] Ultrasonography can be sometimes used in the early stages of LCPD to demonstrate a joint effusion in a child presenting with a limp. […] Technetium scanning is a sensitive means of diagnosing LCPD in the early stages before it is evident radiographically. […] Computed tomography (CT) is able to provide accurate three-dimensional images demonstrating the shape and relationship of the femoral head and acetabulum and provide early diagnosis of bone collapse, curvilinear zones of sclerosis, and subtle changes in bone trabecular pattern. […] Hip arthrography is utilized to demonstrate the dynamic relationship between acetabulum and femoral head in various leg positions.

• #34 Legg-Calvé-Perthes Disease | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/legg-calve-perthes/

  The diagnosis of Legg-Calv-Perthes disease (also known as Perthes disease) is based on a detailed history, physical examination and confirmed by imaging. An X-ray will show the change in the bone structure of the head of the femur. In certain cases your doctor may choose to have a CT scan of your child’s hip. An MRI is often performed to give the doctor more information about the bone and the extent of the disease process. […] At the Hip Program at Children’s Colorado, our orthopedic providers work specifically with pediatric hip conditions. We use X-rays, CT scans and MRI to determine a diagnosis. […] Our hospital uses a special MRI technique called Perfusion MRI, which provides your child’s doctor with a more accurate measurement of the amount of bone that is affected by Perthes disease. This allows a diagnosis to be made earlier in the disease process and also allows doctors to see implications of how the disease will progress. […] Our providers are able to diagnosis your child’s condition based on patient history and age, the results of the physical examination (including pain and/or limitation of motion) and the results of the ordered imaging studies (such as an X-ray or the MRI).

• #35 Perthes Disease | International Perthes Study Group

  https://perthesdisease.org/perthes/

  MRI with gadolinium, or contrast-enhanced, generates detailed pictures of blood flow in the femoral head allowing physicians to quickly tell how much of the femoral head is affected with Perthes. […] MRI with gadolinium, also called perfusion MRI, is very sensitive imaging tool that provides blood flow status of the hip. It is able to detect the lack of blood flow in the femoral head before any x-ray changes occur. […] Hip arthrography is generally performed in the operating room. A dye is injected into the hip joint space and x-rays are taken with the affect leg in different positions to assess the shape of the femoral head and how well it is fitting into the socket or acetabulum.

• #36 Legg-Calvé-Perthes disease | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/legg-calve-perthes-disease

  In addition to a complete medical history and physical examination, diagnostic procedures for Legg-Calv-Perthes disease may include: […] A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. […] A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. […] A specialized type of MRI using dye (contrast) injected through an IV that allows doctors to understand areas of the hip that are getting good blood flow and areas where blood flow is deficient. This is one of the best tests to identify Perthes early before irreversible changes occur.

• #37 Perthes Disease | International Perthes Study Group

  https://perthesdisease.org/perthes/

  X-rays are usually obtained every 3-4 months during the active stage of Perthes to see if the disease is getting worse or better. X-rays of the hip can appear normal if symptoms arise during the very early stage of Perthes and if they have a short duration of only 1-2 months. In these cases, MRI may be required to make the diagnosis. […] Bone scans, or scintigraphy, use radioactive material that collects in the areas of blood flow and increased bone remodeling or regrowth. Thus, the bone scan shows no radioactive material collection in the early stage of Perthes when there is no blood flow to the femoral head which is a sensitive way to see that the blood flow to the femoral head has been affected. […] Regular MRI without contrast provides detailed anatomical information about the affected hip joint in Perthes including hip joint inflammation, amount of deformity, and which part of the femoral head is affected.

• #38 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  Because the course of Legg-Calvé-Perthes disease (LCPD) is highly variable, its appropriate diagnostic evaluation and treatment are still debated. […] The diagnostic evaluation is performed in standard fashion with x-ray views in two planes. The pelvic survey film and lateral hip x-ray serve not only to establish the diagnosis, but also to enable classification, prognostic assessment, and follow-up of the course of the disease. […] Ultrasonography can be used as a supplementary technique to diagnose changes of the femoral head and, in particular, any accompanying synovitis or effusion. […] Magnetic resonance imaging (MRI) is of particular value in identifying the early stage of Perthes disease in the absence of changes on plain films, as well as in cases where the differential diagnosis would otherwise be difficult.

• #39 Perthes disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/perthes-disease?lang=us

  Perthes disease is a diagnosis of exclusion and other causes of osteonecrosis (including sickle cell disease, leukemia, corticosteroid administration, Gaucher disease) must be ruled out. […] The best initial test for the diagnosis of Perthes is a pelvic radiograph. In a small number of patients with Perthes, the radiograph will be normal and persistent symptoms will trigger further imaging, e.g. MRI. […] MRI is gaining an increasing role in a number of scenarios: early diagnosis, before the onset of x-ray findings; assessing the extent of cartilaginous involvement, important in prognosis; assessing joint congruence in a variety of joint positions (requires open magnet and dynamic imaging). […] Bone scintigraphy may show reduced uptake in the femoral head in the early stages of the disease, representing the reduced blood supply of osteonecrosis. In the later stages of the disease, there may be increased uptake reflecting a combination of repair of the femoral head and degenerative change in the femoral head and acetabulum.

• #40 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  Because the course of Legg-Calvé-Perthes disease (LCPD) is highly variable, its appropriate diagnostic evaluation and treatment are still debated. […] The diagnostic evaluation is performed in standard fashion with x-ray views in two planes. The pelvic survey film and lateral hip x-ray serve not only to establish the diagnosis, but also to enable classification, prognostic assessment, and follow-up of the course of the disease. […] Ultrasonography can be used as a supplementary technique to diagnose changes of the femoral head and, in particular, any accompanying synovitis or effusion. […] Magnetic resonance imaging (MRI) is of particular value in identifying the early stage of Perthes disease in the absence of changes on plain films, as well as in cases where the differential diagnosis would otherwise be difficult.

• #41 Legg-Calvé-Perthes Disease: Diagnosis, Imaging, and Classifications | Radiology Key

  https://radiologykey.com/legg-calve-perthes-disease-diagnosis-imaging-and-classifications/

  Although radiography is useful in assessing disease progression, it lacks the sensitivity and specificity needed to demonstrate changes during the early stages of the disease. […] Ultrasonography can be sometimes used in the early stages of LCPD to demonstrate a joint effusion in a child presenting with a limp. […] Technetium scanning is a sensitive means of diagnosing LCPD in the early stages before it is evident radiographically. […] Computed tomography (CT) is able to provide accurate three-dimensional images demonstrating the shape and relationship of the femoral head and acetabulum and provide early diagnosis of bone collapse, curvilinear zones of sclerosis, and subtle changes in bone trabecular pattern. […] Hip arthrography is utilized to demonstrate the dynamic relationship between acetabulum and femoral head in various leg positions.

• #42 Patient Education | Concord Orthopaedics

  https://www.concordortho.com/patient-resources/patient-education/topic/8de6c8d126950dbbae6601bda872854b

  The history and physical examination are usually enough to make the doctor highly suspicious about the diagnosis of Perthes disease. X-rays are usually necessary to make the diagnosis. […] It is usually not necessary to get an MRI scan to make the diagnosis. However, this test may be useful to determine whether the other hip is involved in the disease. A special MRI using a dye called gadolinium may help show changes in blood supply before anything shows up on an X-ray. […] In planning treatment another test, called an arthrogram, may be required. In this test, dye is injected into the hip joint to outline the cartilage surface of the joint. Much of the child’s hip joint is made up of cartilage. Cartilage does not usually show up on X-rays. The dye is necessary to see what the hip will actually look like when the cartilage turns to bone.

• #43 Perthes Disease | International Perthes Study Group

  https://perthesdisease.org/perthes/

  MRI with gadolinium, or contrast-enhanced, generates detailed pictures of blood flow in the femoral head allowing physicians to quickly tell how much of the femoral head is affected with Perthes. […] MRI with gadolinium, also called perfusion MRI, is very sensitive imaging tool that provides blood flow status of the hip. It is able to detect the lack of blood flow in the femoral head before any x-ray changes occur. […] Hip arthrography is generally performed in the operating room. A dye is injected into the hip joint space and x-rays are taken with the affect leg in different positions to assess the shape of the femoral head and how well it is fitting into the socket or acetabulum.

• #44 Legg-Calvé-Perthes Disease: Diagnosis, Imaging, and Classifications | Radiology Key

  https://radiologykey.com/legg-calve-perthes-disease-diagnosis-imaging-and-classifications/

  Although radiography is useful in assessing disease progression, it lacks the sensitivity and specificity needed to demonstrate changes during the early stages of the disease. […] Ultrasonography can be sometimes used in the early stages of LCPD to demonstrate a joint effusion in a child presenting with a limp. […] Technetium scanning is a sensitive means of diagnosing LCPD in the early stages before it is evident radiographically. […] Computed tomography (CT) is able to provide accurate three-dimensional images demonstrating the shape and relationship of the femoral head and acetabulum and provide early diagnosis of bone collapse, curvilinear zones of sclerosis, and subtle changes in bone trabecular pattern. […] Hip arthrography is utilized to demonstrate the dynamic relationship between acetabulum and femoral head in various leg positions.

• #45 Legg-Calvé-Perthes Disease: Diagnosis, Imaging, and Classifications | Radiology Key

  https://radiologykey.com/legg-calve-perthes-disease-diagnosis-imaging-and-classifications/

  Legg-Calv-Perthes Disease: Diagnosis, Imaging, and Classifications […] Several different imaging techniques are available to diagnose LCPD. Each technique has advantages and disadvantages and will be described within this section of the chapter. […] Plain radiography remains the primary diagnostic assessment tool for LCPD. An anteroposterior (AP) and frog-leg lateral radiograph of the pelvis are used to determine the radiographic stage of the disease, the extent of head involvement and serial progression of the disease. […] Much research effort has been expended to use earlier radiographic features to determine the prognosis and the long-term outcome. Catterall, Salter-Thompson, and lateral pillar classifications described below are such classifications which can be used in the fragmentation stage of the disease to prognosticate outcome, whereas the Stulberg classification is used at the healed stage near or at skeletal maturity.

• #46 Legg-Calvé-Perthes Disease: Diagnosis, Imaging, and Classifications | Radiology Key

  https://radiologykey.com/legg-calve-perthes-disease-diagnosis-imaging-and-classifications/

  MRI is an accurate imaging modality for the early diagnosis of LCPD. It allows assessment of the extent of femoral head ischemia and provides visualization of the cartilaginous portion of the femoral head and acetabulum. […] The role of MRI in the management of LCPD is currently evolving as MRI techniques and our understanding of LCPD evolve. […] Radiographic classifications and quantitative indices for LCPD can be divided into three types: those that define the stage and progression of the disease, those developed to prognosticate outcome during the active stage of the disease, and those that assess the short-term or longer-term outcome. […] Waldenstrm described four radiographic stages of disease progression: the initial or avascular necrosis stage, fragmentation or resorptive stage, reossification or healing stage, and healed stage. […] The modified staging is referred to as the Elizabethtown classification. Each of the first original three stages described by Waldenstrm was further subdivided into two substages.

• #47 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  The radiologically demonstrable stages that all children with Perthes disease pass through are based on the scheme devised by Waldenström. […] The most recent classification was proposed by Herring in 1992. It is based on the height of the lateral pillar of the epiphysis of the femoral head, as seen on an AP x-ray view in the early fragmentation phase. […] The predictive value of the Herring classification is higher when the patient’s age at the onset of the disease is also taken into account. […] The goal of all forms of treatment is to prevent deformity of the femoral head and incongruence of the affected hip. […] The extent of incongruence in adolescence determines the severity of the prearthrotic deformity, and thus also the probability of early secondary coxarthrosis. […] The type of treatment that is to be provided is determined on the basis of the radiological severity of the disease, the presence or absence of „head-at-risk signs,” the extent of limitation of mobility of the hip joint, and the age of the patient.

• #48

  https://journals.lww.com/jbjsjopa/fulltext/2024/09000/diagnosis_and_management_of_legg_calv__perthes.4.aspx

  Legg-Calv-Perthes disease is divided into 4 stages based on the Waldenstrom criteria: initial/necrosis (stage I), fragmentation (stage II), reossification (stage III), and healed/residual (stage IV). […] The Waldenstrom criteria are based on radiographic changes that occur as the disease progresses. […] Surgical interventions for LCPD include femoral osteotomy, salter osteotomy, and arthrodiastasis. […] Treatment modalities for LCPD range from self-management of the disease to surgical interventions. […] Providers should be aware of the atypical clinical presentation of LCPD in an obese child. […] Delayed diagnosis is directly correlated with increased morbidity and disability later in life.

• #49 Perthes Disease | International Perthes Study Group

  https://perthesdisease.org/perthes/

  Perthes disease goes through 4 stages. These are called Waldenstrm radiographic stages as it was first described by Dr Waldenstrm using x-rays. The diagnosis requires a careful history, physical examination, and x-rays. In patients with Perthes, leg pain, decreased hip movement, and limping are seen. Since these symptoms and signs are not specific to the disease, x-rays are required to confirm Perthes. […] In Perthes, x-rays will show changes to the appearance and the shape of the femoral head. Based on the changes, the stage of the disease can be determined. Magnetic resonance imaging (MRI) using gadolinium contrast can assess the blood flow to the femoral head and provide more detailed information about how much of the femoral head is affected. […] X-rays are a mainstay of diagnosis and management of Perthes. First, x-rays help physicians determine how far along the disease has progressed. Second, x-rays also provide information about the amount of hip deformity over the course of the disease and can show if the femoral head is developing signs associated with a poor outcome.

• #50 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  The radiologically demonstrable stages that all children with Perthes disease pass through are based on the scheme devised by Waldenström. […] The most recent classification was proposed by Herring in 1992. It is based on the height of the lateral pillar of the epiphysis of the femoral head, as seen on an AP x-ray view in the early fragmentation phase. […] The predictive value of the Herring classification is higher when the patient’s age at the onset of the disease is also taken into account. […] The goal of all forms of treatment is to prevent deformity of the femoral head and incongruence of the affected hip. […] The extent of incongruence in adolescence determines the severity of the prearthrotic deformity, and thus also the probability of early secondary coxarthrosis. […] The type of treatment that is to be provided is determined on the basis of the radiological severity of the disease, the presence or absence of „head-at-risk signs,” the extent of limitation of mobility of the hip joint, and the age of the patient.

• #51 Legg-Calvé-Perthes Disease: Diagnosis, Imaging, and Classifications | Radiology Key

  https://radiologykey.com/legg-calve-perthes-disease-diagnosis-imaging-and-classifications/

  Legg-Calv-Perthes Disease: Diagnosis, Imaging, and Classifications […] Several different imaging techniques are available to diagnose LCPD. Each technique has advantages and disadvantages and will be described within this section of the chapter. […] Plain radiography remains the primary diagnostic assessment tool for LCPD. An anteroposterior (AP) and frog-leg lateral radiograph of the pelvis are used to determine the radiographic stage of the disease, the extent of head involvement and serial progression of the disease. […] Much research effort has been expended to use earlier radiographic features to determine the prognosis and the long-term outcome. Catterall, Salter-Thompson, and lateral pillar classifications described below are such classifications which can be used in the fragmentation stage of the disease to prognosticate outcome, whereas the Stulberg classification is used at the healed stage near or at skeletal maturity.

• #52 Legg-Calvé-Perthes disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/legg-calve-perthes-disease/

  Legg-Calv-Perthes disease (LCPD or Perthes disease) refers to an idiopathic, avascular necrosis of the femoral head. […] Early stages are only detectable on MRI but progress of the disease can be tracked and graded using conventional x-ray. […] Surgery is performed if x-ray reveals signs that indicate an unfavorable prognosis. […] The aim of surgical intervention is to cover the femoral head as completely as possible with the hip socket, thus retaining its anatomical position. […] Important prognostic factors include the age of onset and the extent of femoral head involvement. […] X-ray (anterior-posterior and frog leg positions) […] Frequently without pathological findings during early stages […] Increased lucency of the femoral head […] Flattening and fragmentation of the femoral head […] Joint space widening […] Head-at-risk signs: prognostically unfavorable radiographic signs (as defined by complementary Catterall classification) […] MRI: indicated if initial imaging is unremarkable but clinical suspicion persists.

• #53 Perthes disease | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/perthes-disease?lang=us

  Perthes disease is a diagnosis of exclusion and other causes of osteonecrosis (including sickle cell disease, leukemia, corticosteroid administration, Gaucher disease) must be ruled out. […] The best initial test for the diagnosis of Perthes is a pelvic radiograph. In a small number of patients with Perthes, the radiograph will be normal and persistent symptoms will trigger further imaging, e.g. MRI. […] MRI is gaining an increasing role in a number of scenarios: early diagnosis, before the onset of x-ray findings; assessing the extent of cartilaginous involvement, important in prognosis; assessing joint congruence in a variety of joint positions (requires open magnet and dynamic imaging). […] Bone scintigraphy may show reduced uptake in the femoral head in the early stages of the disease, representing the reduced blood supply of osteonecrosis. In the later stages of the disease, there may be increased uptake reflecting a combination of repair of the femoral head and degenerative change in the femoral head and acetabulum.

• #54 Legg–Calvé–Perthes disease overview | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-022-02275-z

  LeggCalvPerthes Disease (LCPD) is characterized by, unilateral or bilateral, necrosis of the femoral head (FH). Which affects the range of motion of the hip. […] Although LCPD was first described in the beginning of the past century and has been studied for more than 100 years, limited is known about its etiology. […] However, even though different diagnosis methods and treatments have been used throughout history, the etiology of LCPD remains unknown. […] Due to lack of information, LCPD diagnosis can be difficult; nevertheless, there are some important diagnostic criteria (Table 2). Differential diagnoses that must be considered given the radiographic findings include, coxitis fugax, Meyer dysplasia, epiphyseal dysplasia, spondyloepiphyseal dysplasia, chondroblastoma, juvenile idiopathic arthritis, drug-induced femoral head necrosis, Gauchers disease, sickle cell anemia, thalassemia, achondroplasia and Klinefelter syndrome.

• #55 Legg–Calvé–Perthes disease overview | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-022-02275-z

  LeggCalvPerthes Disease (LCPD) is characterized by, unilateral or bilateral, necrosis of the femoral head (FH). Which affects the range of motion of the hip. […] Although LCPD was first described in the beginning of the past century and has been studied for more than 100 years, limited is known about its etiology. […] However, even though different diagnosis methods and treatments have been used throughout history, the etiology of LCPD remains unknown. […] Due to lack of information, LCPD diagnosis can be difficult; nevertheless, there are some important diagnostic criteria (Table 2). Differential diagnoses that must be considered given the radiographic findings include, coxitis fugax, Meyer dysplasia, epiphyseal dysplasia, spondyloepiphyseal dysplasia, chondroblastoma, juvenile idiopathic arthritis, drug-induced femoral head necrosis, Gauchers disease, sickle cell anemia, thalassemia, achondroplasia and Klinefelter syndrome.

• #56 Perthes’ Disease. Symptoms of perthes’? Causes, effects

  https://patient.info/doctor/perthes-disease-pro

  Investigations will include: […] Early X-rays may show widening of the joint space (the best view is frog lateral), or may be normal. […] Technetium bone scan or MRI scanning can be used to identify pathology (seen as an area of reduced perfusion). […] An arthrogram and/or MRI scan are often needed to assess congruency throughout full range of movement. A flat-topped incongruent head has the worst prognosis. […] Hip aspiration if a septic joint is suspected.

• #57 Legg-Calve-Perthes Disease – Core EM

  https://coreem.net/core/legg-calve-perthes-disease/

  Legg-Calve-Perthes Disease (LCPD) is a pediatric hip disorder exemplified by idiopathic avascular necrosis (AVN) of the femoral head. […] Early stages of disease typically exemplify normal hip imaging. […] Plain radiographic changes can be delayed versus clinical onset of symptoms, thus MRI/bone scans may be performed for expedited diagnosis. […] Goals of treatment are to diminish pain, maintain active hip motion, and prevent/minimize potential permanent femoral head deformity to reduce development of degenerative arthritis. […] Exclude other causes of hip pain prior to LCPD diagnosis.

• #58 Legg-Calvé-Perthes Disease – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/bone-disorders-in-children/legg-calv%C3%A9-perthes-disease

  Diagnosis of Legg-Calv-Perthes disease is suspected based on symptoms. […] X-rays are usually obtained and, if needed, an MRI is done to confirm the diagnosis and extent of the lesion. […] In bilateral or familial cases, an x-ray skeletal survey to exclude hereditary skeletal disorders, particularly multiple epiphyseal dysplasia, is mandatory because prognosis and optimal management differ.

• #59 Diagnosing Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/diagnosis

  Orthopedic specialists at Hassenfeld Childrens Hospital use information from these tests to determine when Perthes disease developed and to evaluate the extent of the condition. This helps our doctors develop an individualized treatment plan aimed at preventing further damage to the hip joint and improving mobility and range of motion.

• #60 Guide | Physical Therapy Guide to Perthes Disease | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-legg-calve-perthes-disease

  Perthes disease is a complex bone disorder that can last from several months to years. […] Early diagnosis and treatment of Perthes disease are vital to ensure long-term health. […] A health care provider will take the child’s health history. During the exam, they may: […] Order X-rays (which are required to confirm Perthes disease). […] Orthopedic surgeons and radiologists rely on X-ray images to determine the stage and extent of Perthes disease. […] Early diagnosis is crucial to aid full recovery. […] If more than 50% of the femoral head is affected, the potential for regrowth without deformity is lower. […] A physical therapist will carefully examine the child. They will develop an exercise program designed to help restore normal hip movement and promote age-appropriate functional skills.

• #61 Traumatología infantil | Enfermedad de Legg-Calvé Perthes

  https://elgeaditraumatologia.com/en/enfermedad-legg-calve-perthes-tratamiento/

  Legg-Calvé Perthes disease is a condition that damages the hip in children and can cause pain and limitation of movement. […] The symptoms of Perthes disease may coincide with other conditions such as hip dysplasia, so it is important to consult with a trusted professional to carry out a correct diagnosis. […] When symptoms appear, the health professional can perform the following tests: Complete physical examination: the health professional will look for loss of hip mobility and characteristic lameness. […] X-rays: in order to observe both the change in bone shape and the loss of density. […] In some cases, an MRI or bone scan may be helpful to find out the stage of the disease and the amount of tissue affected. […] The younger the child is at the time of diagnosis, the better the prognosis for recovery; It is important to go as soon as possible to a orthopedic doctor if the child limps or complains of pain in the hip, thigh or knee.

• #62 Perthes Disease (Legg-Calvé-Perthes Disease): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/orthopedics/columbia-orthopedics/perthes-disease/treatment

  A healthcare provider will order an X-ray to confirm a diagnosis if symptoms of Legg-Calv-Perthes disease are present. MRI scans can be used to determine how much the disease has affected the blood supply in the area. […] Physical examinations can be used to detect these issues, while blood tests can be used to eliminate other conditions, such as infection, that may cause similar symptoms. […] Pediatric surgeons at Columbia Orthopedics can guide and provide care in diagnosing and treating Legg-Calv-Perthes disease. Our experts can confirm a diagnosis using an X-ray and will perform regular tests to track progression and recovery. Early diagnosis will allow more time for the femoral head to heal and recover.

• #63

  https://journals.lww.com/jbjsjopa/fulltext/2024/09000/diagnosis_and_management_of_legg_calv__perthes.4.aspx

  Legg-Calv-Perthes disease is divided into 4 stages based on the Waldenstrom criteria: initial/necrosis (stage I), fragmentation (stage II), reossification (stage III), and healed/residual (stage IV). […] The Waldenstrom criteria are based on radiographic changes that occur as the disease progresses. […] Surgical interventions for LCPD include femoral osteotomy, salter osteotomy, and arthrodiastasis. […] Treatment modalities for LCPD range from self-management of the disease to surgical interventions. […] Providers should be aware of the atypical clinical presentation of LCPD in an obese child. […] Delayed diagnosis is directly correlated with increased morbidity and disability later in life.

• #64 Perthes Disease | International Perthes Study Group

  https://perthesdisease.org/perthes/

  X-rays are usually obtained every 3-4 months during the active stage of Perthes to see if the disease is getting worse or better. X-rays of the hip can appear normal if symptoms arise during the very early stage of Perthes and if they have a short duration of only 1-2 months. In these cases, MRI may be required to make the diagnosis. […] Bone scans, or scintigraphy, use radioactive material that collects in the areas of blood flow and increased bone remodeling or regrowth. Thus, the bone scan shows no radioactive material collection in the early stage of Perthes when there is no blood flow to the femoral head which is a sensitive way to see that the blood flow to the femoral head has been affected. […] Regular MRI without contrast provides detailed anatomical information about the affected hip joint in Perthes including hip joint inflammation, amount of deformity, and which part of the femoral head is affected.

• #65 Perthes Disease

  https://www.karolinskahospital.com/care-at-karolinska/conditions/perthes-disease/

  Follow-up care is an important part of diagnosing and managing Perthes disease. The child’s progress will be closely monitored through regular appointments with the children orthopedic specialist. Additional imaging tests may be ordered to assess the progression of the disease and the effectiveness of the treatment plan.

• #66 Perthes Disease

  https://www.karolinskahospital.com/care-at-karolinska/conditions/perthes-disease/

  Follow-up care is an important part of diagnosing and managing Perthes disease. The child’s progress will be closely monitored through regular appointments with the children orthopedic specialist. Additional imaging tests may be ordered to assess the progression of the disease and the effectiveness of the treatment plan.

• #67 Legg-Calve-Perthes Disease | Texas Children’s

  https://www.texaschildrens.org/content/conditions/legg-calve-perthes-disease

  Legg-Calve-Perthes disease is a problem with the ball-and-socket joint where the femur (thighbone) and pelvis meet. It happens when the joint temporarily does not get enough blood. This causes the bone to die, making it more likely to break. The ball part of the socket becomes flat and more difficult to move. […] To test for Legg-Calve-Perthes disease, the doctor first will complete a detailed medical history and physical exam. The doctor will examine the child for a limp or loss of hip motion. […] Other tests may be done, including imaging tests, such as X-rays or MRI (magnetic resonance imaging). […] Early diagnosis and regular follow-up visits with an orthopedic specialist are important.

• #68 Legg Calve Perthes Disease: Symptoms & Treatment – OAWF

  http://www.orthowestfl.com/perthes-disease/

  Diagnosis Your doctor will make a diagnosis based on your childs medical history, a thorough physical examination, and X-rays. […] Your child must be assessed until they are skeletally mature. In general, the younger the age of onset of the condition, the better the chances for full recovery.

• #69 Legg-Calvé-Perthes Disease: Diagnosis, Decision Making, and Outcome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38315432/

  Legg-Calv-Perthes disease (LCPD), or idiopathic avascular necrosis of the proximal capital femoral epiphysis in children, has a variable presentation and can result in significant femoral head deformity that can lead to long-term functional deficits. Plain radiographic imaging is crucial in diagnosing LCPD and guiding treatment. […] Advanced imaging using perfusion MRI may refine surgical decision making in the future, and biological treatments to improve femoral head healing are on the horizon.

• #70 Understanding Legg-Calvé-Perthes disease – Children’s National

  https://innovationdistrict.childrensnational.org/understanding-legg-calve-perthes-disease/

  Legg-Calv-Perthes disease, which affects between five and 10 of every 100,000 children each year, is so rare that it can sometimes be challenging for clinicians to know how best to care for affected patients. […] Recently, Dr. Martin and two study group colleagues published a review study that outlines common imaging modalities used in the diagnosis and treatment of Perthes disease. […] Today, radiography remains the most common imaging technique used to diagnose and follow Perthes over time. However, some MRI applications may offer additional insight into the disorder. […] This study was one of a handful that the international Perthes group has published so far, with several more currently under development. Exploring treatments and technology applications will enhance early diagnosis and treatment for Perthes, which is a crucial component of treatment success and improved quality of life for affected children.

• #71 Legg-Calvé-Perthes Disease: Diagnosis, Decision Making, and Outcome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38315432/

  Legg-Calv-Perthes disease (LCPD), or idiopathic avascular necrosis of the proximal capital femoral epiphysis in children, has a variable presentation and can result in significant femoral head deformity that can lead to long-term functional deficits. Plain radiographic imaging is crucial in diagnosing LCPD and guiding treatment. […] Advanced imaging using perfusion MRI may refine surgical decision making in the future, and biological treatments to improve femoral head healing are on the horizon.

• #72 Understanding Legg-Calvé-Perthes disease – Children’s National

  https://innovationdistrict.childrensnational.org/understanding-legg-calve-perthes-disease/

  Legg-Calv-Perthes disease, which affects between five and 10 of every 100,000 children each year, is so rare that it can sometimes be challenging for clinicians to know how best to care for affected patients. […] Recently, Dr. Martin and two study group colleagues published a review study that outlines common imaging modalities used in the diagnosis and treatment of Perthes disease. […] Today, radiography remains the most common imaging technique used to diagnose and follow Perthes over time. However, some MRI applications may offer additional insight into the disorder. […] This study was one of a handful that the international Perthes group has published so far, with several more currently under development. Exploring treatments and technology applications will enhance early diagnosis and treatment for Perthes, which is a crucial component of treatment success and improved quality of life for affected children.

• #73 Perthes Disease

  https://www.karolinskahospital.com/care-at-karolinska/conditions/perthes-disease/

  Diagnosing Perthes disease typically involves a combination of thorough medical history, physical examination and imaging tests with the key to right early diagnosis being a caregiver with clinical experience and good knowledge of the various conditions affecting the hip during childhood. […] Physical examination includes not only assessment of the hip joints range of motion, pain and other abnormalities but focuses on the whole child as a person to not miss other medical conditions and be able to provide the best treatment plan with the wellbeing of the child being the highest priority. […] Imaging tests as X-Ray usually suffice for the diagnosis and may need to be repeated after 3-4 months if the initial examination is normal. In a few selected cases other modalities such as magnetic resonance imaging (MRI), or computed tomography (CT) scans may be ordered to confirm the diagnosis and determine the extent of the damage to the hip joint.

• #74 Diagnosing Legg-Calvé-Perthes Disease in Children | NYU Langone Health

  https://nyulangone.org/conditions/legg-calve-perthes-disease-in-children/diagnosis

  Orthopedic specialists at Hassenfeld Childrens Hospital use information from these tests to determine when Perthes disease developed and to evaluate the extent of the condition. This helps our doctors develop an individualized treatment plan aimed at preventing further damage to the hip joint and improving mobility and range of motion.

• #75 Guide | Physical Therapy Guide to Perthes Disease | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-legg-calve-perthes-disease

  Physical therapists are important members of the health care team that works with children who have Perthes disease. […] A physical therapist can develop a treatment program to: […] Educate the child and parents about safe ways to move at home and in the community that follow the surgeons guidelines for bearing weight after the operation. […] Noticing and identifying symptoms early is crucial to recovery. […] Researchers continue to try to understand the cause of Perthes disease and to improve conservative care and surgery. […] All physical therapists are prepared through education and experience to treat patients with Perthes disease. […] You may want to consider: […] A physical therapist who is experienced in pediatric and orthopedic disorders. […] A physical therapist who is a board-certified clinical specialist or who has completed residency, fellowship, or training in pediatric or orthopedic physical therapy. […] An experienced pediatric physical therapist who also understands the importance of working with orthopedic surgeons who guide the rehabilitation plan needed to ensure the best possible outcomes for children with Perthes disease.

• #76 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  The treatment of pain is important mainly in the initial phase, in which acute inflammation is present. […] If the disease takes an unfavorable course, or if conservative therapy fails, a number of operative methods of improving containment may be indicated. […] As the course of Perthes disease is variable, the appropriate treatment must be determined individually for each patient.

• #77 Perthes Disease: Current Principles of Diagnosis and Treatment – PMC Lock

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2735835/

  The radiologically demonstrable stages that all children with Perthes disease pass through are based on the scheme devised by Waldenström. […] The most recent classification was proposed by Herring in 1992. It is based on the height of the lateral pillar of the epiphysis of the femoral head, as seen on an AP x-ray view in the early fragmentation phase. […] The predictive value of the Herring classification is higher when the patient’s age at the onset of the disease is also taken into account. […] The goal of all forms of treatment is to prevent deformity of the femoral head and incongruence of the affected hip. […] The extent of incongruence in adolescence determines the severity of the prearthrotic deformity, and thus also the probability of early secondary coxarthrosis. […] The type of treatment that is to be provided is determined on the basis of the radiological severity of the disease, the presence or absence of „head-at-risk signs,” the extent of limitation of mobility of the hip joint, and the age of the patient.

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