IS Case 235: Legg-Calve-Perthes disease
Imaging Sciences URMC 2008
Publication Date: 2009-05-26
AP views of the left hip demonstrate deformity of the left proximal femur with flattening of the femoral head and shortening of the femoral neck. There is lateral subluxation of the femur, with widening of the medial joint space and superolateral joint space narrowing. Findings are consistent with sequela of underlying Legg-Calve-Perthes disease.
Legg-Calve-Perthes disease is a self limiting hip disorder caused by a varying degree of ischemia and subsequent necrosis of the femoral head, most typically affecting 4-8 year old boys with delayed skeletal maturity. Prognosis is associated with age at onset, with onset after the age of 8 years associated with poor prognosis.
At least 50% of involved hips do well with no treatment, but degenerative joint disease (DJD) can develop in the 5th decade due to asphericity of the hip joint. A flat topped femoral head which is incongruent with the acetabulum has the worst prognosis.
Severity of disease can be categorized using the Stulberg classification system. There are five classes within the Stulberg classification.
- Class one is represented by a normal hip radiographically and a spherical femoral head.
- Class two has a spherical femoral head but may have coxa magna, a shorter than normal femoral neck, or an abnormally steep acetabulum radiographically.
- In class three the femoral head is aspherical, mushroom shaped, coxa magna is present, an abnormal acetabulum, and a short femoral neck are radiographically present.
- In class four the femoral head is aspherical and there are abnormalities of the acetabulum, neck, and head of the femur demonstrated radiographically.
- Class five consists of an aspherical head.
- Wheeless CR III. Legg-Calve-Perthes disease. Wheeless' Textbook of Orthopaedics. http://www.wheelessonline.com/ortho/legg_calve_perthes_disease
- Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: Classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. 2004 Oct;86-A(10):2103-20. [PMID: 15466719]