Legg-Calve-Perthes Disease

Definition

  • Most common 4 – 8 years of age
  • Male: female 4-5: 1
  • Bilateral in 10-12%
  • No evidence that it is inherited
  • Children are often small for their age
  • Has been associated with ADD

Western Health Orthopaedic Registrar presentation – Legg-Calve Perthes Disease by Dr David Slattery

Presentation by Dr Praveen Kumar

Aetiology

  • Idiopathic interruption of blood supply to the capital femoral epiphysis
  • Associations with thrombophilia, passive smoking, low socioeconomic status and delayed bone age

Pathology

  • Waldenström stages are initial, fragmentation, reossification and healed
  • Lateral extrusion and collapse lead to aspherical head and hinge abduction

Classification

Herring lateral pillar (fragmentation stage)

GroupDescription
ALateral pillar height fully preserved
BOver 50% of lateral pillar height preserved
B/C borderNarrow or poorly ossified pillar near 50%
CUnder 50% of lateral pillar height preserved

Original publication Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1992;12(2):143-50.

Catterall head at risk signs

  • Gage sign, lateral calcification, lateral subluxation, horizontal physis and metaphyseal cysts

Stulberg (at maturity)

ClassDescription
I and IISpherical head, low arthritis risk
III and IVOvoid or flat congruent head
VFlat head with incongruent joint, highest arthritis risk

Original publication Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63(7):1095-108.

Clinical Features

  • Limp with mild pain, often referred to the knee
  • Loss of abduction and internal rotation

Investigations

Legg-Calve-Perthes Disease, radiograph of the hips in legg-calvé-perthes disease
Radiograph of the hips in Legg-Calvé-Perthes disease. Image by J. Lengerke, Wikimedia Commons, Public domain.
  • AP and frog lateral pelvic radiographs
  • MRI or bone scan in the early stage

Management

  • Aim to contain the femoral head and preserve ROM
  • Onset under 6 years, observation and physiotherapy
  • Onset over 8 years with pillar B or B/C, femoral or pelvic osteotomy improves outcome (Herring 2004)
  • Hinge abduction treated with valgus extension osteotomy or shelf acetabuloplasty

Prognosis

  • Worse with older onset, female sex, pillar C and head at risk signs
  • Stulberg class predicts adult osteoarthritis

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.