Epidemiology, pathogenesis, and treatment of Legg-Calvé-Perthes disease: Current concepts

Epidemiological studies confirm a profound geographical predilection for Legg-Calvé-Perthes disease. The disease appears to be related to social deprivation, and passive smoke inhalation may be one contributory mechanism. A definite trend of reduction in the incidence of the disease over time has been documented. Experimental studies demonstrate an imbalance between osteoclastic resorption and new bone deposition, with the former taking precedence in the early part of the disease, resulting in a predisposition for femoral head collapse and deformation. A clearer separation of treatment into preventive treatment, remedial treatment, and salvage based on the timing of intervention during the course of the disease has emerged. Containment by femoral osteotomy, innominate osteotomy, or the shelf procedures appear to be effective in preserving the sphericity of the femoral head if performed early in the course of the disease. The role of intervention later in the course of the disease and the management of hinge abduction have been defined more clearly. There is enthusiasm to correct the structural alterations in deformed femoral heads by "joint preserving operations" through surgical hip dislocation. The long-term benefits of these operations are unknown. Experimental studies suggest that modulation of osteoclastic function prevents femoral head collapse.