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# Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease is loss of blood supply to the ball of the hip in a growing child; the bone softens, then slowly regrows, sometimes flattened.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Femur](https://durgical.com/en/anatomy/femur/)
- [Femoral head cartilage](https://durgical.com/en/anatomy/articular-cartilage-of-femoral-head/)
- [Circumflex femoral arteries](https://durgical.com/en/anatomy/medial-circumflex-femoral-artery/)
- [Hip bone](https://durgical.com/en/anatomy/hip-bone/)
- [Acetabular cartilage](https://durgical.com/en/anatomy/articular-cartilage-of-acetabulum/)
- [Hip capsule](https://durgical.com/en/anatomy/articular-capsule-of-hip-joint/)
- [Ligament of the femoral head](https://durgical.com/en/anatomy/ligament-of-head-of-femur/)

## In the clinical exam

- [Trendelenburg sign and gait](https://durgical.com/en/clinical-exam/trendelenburg-sign-and-gait/)

## Why it happens

- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/)

## What it is

Idiopathic avascular necrosis of the femoral head in a growing child, followed by fragmentation and slow regrowth of the bone, which can leave the head flattened.

## Who gets it

Mainly affects boys, typically between about 4 and 8 years old; most cases are unilateral. It is less common than transient synovitis, the usual cause of a limp in this age group.

## Causes

- Interruption of blood supply to the femoral head epiphysis; the exact cause is unknown
- Proposed factors include clotting abnormalities, repeated microtrauma and passive smoke exposure

## Risk factors

- Male sex
- Age about 4 to 8 years
- Delayed bone age and short stature
- Low birth weight
- Family history
- Exposure to second-hand smoke

## Pathophysiology

In young children the femoral head depends heavily on the lateral epiphyseal branches of the [medial circumflex femoral artery](https://durgical.com/en/anatomy/medial-circumflex-femoral-artery/). After an ischaemic episode the bone dies, then is resorbed and replaced. While soft, the head can deform and extrude from the acetabulum; the final shape decides the long-term outcome.

## Classification

- Waldenström stages: initial (sclerosis), fragmentation, reossification and healed
- Lateral pillar (Herring) classification during fragmentation, which predicts outcome
- Stulberg classification of the final shape at skeletal maturity

## Symptoms and signs

- Painless or mildly painful limp of gradual onset
- Pain in the groin, thigh or knee, worse with activity
- Limited internal rotation and abduction of the hip
- Thigh muscle wasting and, later, a slight leg-length difference

## Red flags

- Fever, inability to bear weight or a very irritable hip suggests septic arthritis, not Perthes
- Bilateral and symmetric changes suggest a skeletal dysplasia or hypothyroidism

## Diagnosis

**Clinical**
A child with a limp and loss of internal rotation and abduction of the hip, without systemic illness.

**Tests**
Usually normal; inflammatory markers help exclude infection.

**Imaging**
Anteroposterior and frog-leg radiographs show sclerosis, a crescent sign, fragmentation and flattening of the head. MRI shows early changes before radiographs.

## Differential diagnosis

- Transient synovitis of the hip
- Septic arthritis of the hip
- Slipped capital femoral epiphysis
- Multiple epiphyseal dysplasia
- Sickle cell disease or steroid-related avascular necrosis
- Juvenile idiopathic arthritis

## Goal of treatment

Keep the femoral head round and well contained in the acetabulum while it heals, and maintain hip motion.

## Treatment

**Conservative**
Observation, activity modification and pain relief with anti-inflammatory drugs, especially in younger children.

**Rehabilitation**
Physiotherapy to keep range of motion, mainly abduction and internal rotation.

**Surgical**
Containment surgery (femoral or pelvic osteotomy) in older children or with marked involvement; indications vary between centres.

**Follow-up**
Serial radiographs through the stages of the disease until healing.

## Complications

- Flattened, enlarged femoral head (coxa plana, coxa magna)
- Hip joint incongruity and impingement
- Leg-length difference
- Early osteoarthritis of the hip in adulthood

## Prognosis

Most important is age at onset: children under about 6 usually do well. Older age, greater involvement of the lateral pillar and a non-spherical head at maturity predict early arthritis.

## Test yourself

Think of the answer, then tap the question to see it.

## What is Legg-Calvé-Perthes disease?

Idiopathic avascular necrosis of the femoral head epiphysis in a growing child.

## Which patient typically has Legg-Calvé-Perthes disease?

A boy of about 4 to 8 years with a gradual, often painless limp and delayed bone age.

## Which hip movements are lost first in Legg-Calvé-Perthes disease?

Internal rotation and abduction.

## What is the strongest predictor of outcome in Legg-Calvé-Perthes disease?

Age at onset: younger children (under about 6) have a better prognosis.

## What is the principle of treatment in Legg-Calvé-Perthes disease?

Containment: keep the femoral head inside the acetabulum while it heals so it remodels round.

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## Related conditions

- [Slipped capital femoral epiphysis](https://durgical.com/en/conditions/slipped-capital-femoral-epiphysis/)
- [Avascular necrosis of the femoral head](https://durgical.com/en/conditions/avascular-necrosis-of-the-femoral-head/)
- [Developmental dysplasia of the hip](https://durgical.com/en/conditions/developmental-dysplasia-of-the-hip/)
- [Hip Osteoarthritis](https://durgical.com/en/conditions/hip-osteoarthritis/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Legg-Calve-Perthes Disease](https://www.ncbi.nlm.nih.gov/books/NBK513230/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/legg-calve-perthes-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/legg-calve-perthes-disease/