 Limping

 Pain or stiffness in the hip, groin, thigh or knee

 Limited range of motion of the hip joint

 X-rays. Initial X-rays may look normal because it can take one to two months after symptoms begin
for the damage associated with Legg-Calve-Perthes disease to become evident on X-rays. Your
doctor will likely recommend several X-rays over time, to track the progression of the disease.
 Magnetic resonance imaging (MRI). This technology uses radio waves and a strong magnetic field
to produce very detailed images of bone and soft tissue inside the body. MRIs often can visualize
bone damage caused by Legg-Calve-Perthes disease more clearly than X-rays can.
 Bone scan. In this test, a small amount of radioactive material is injected into a vein. The material is
attracted to areas where bone is rapidly breaking down and rebuilding itself, so these areas show up
on the resulting scan images.

Surgery usually isn't needed for children younger than 6. They still have a lot of growing left to do so the femoral head
has more time to repair the damage caused by Legg-Calve-Perthes. Most of this younger age group heal well with
conservative treatments.
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Legg-Calvé-Perthes disease (LCPD) is avascular necrosis of the proximal femoral head

LCPD usually occurs in children aged 4-10 years

The earliest sign of LCPD is an intermittent limp (abductor lurch), especially after exertion, with mild or intermittent
pain in the anterior part of the thigh.

In a Norwegian study of Perthes disease (ie, LCPD), Wiig et al followed 358 patients for 5 years and
determined that proximal femoral varus osteotomy provided the best results in children 6 years and older
with hips having more than 50% femoral head necrosis at the time of diagnosis. [4] They found no significant
difference between physiotherapy and abduction orthosis and therefore suggested abandoning abduction
orthosis for Perthes' disease. For children younger than 6 years, no difference in outcome was determined for
any of the three treatments.

A study by Kim et al suggested that contrary to conventional belief, a greater varus angulation may not
produce better preservation of the femoral head following proximal femoral varus osteotomy. [11]

A meta-analysis of the medical literature addressing the effectiveness of surgical and nonsurgical treatment
of LCPD suggested that there is minimal evidence to determine the most appropriate treatment. [12] This
research also provides some evidence that nontreatment may be as effective as orthotic or surgical
intervention.

Because LCPD is a local self-healing disorder, treatment consists of protection of the joint by allowing new bone
formation to occur and regain a spherical femoral head.

The prognosis for patients with LCPD can be good; it depends on the completeness of involvement of the epiphyseal
center. The severity of involvement of the femoral head, its subsequent healing, and proper joint space preservation all
help determine when and to what degree an athlete will be able to participate in sports. The functional result depends
on the amount of deformity that develops when the structure is softened. Overall, the prognosis for recovery and
sports participation after treatment is very good for most individuals.

The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent
femoral head deformity so that the risk of developing a severe degenerative arthritis as adult can be reduced. [
XR

 stage I: early
 asymmetric femoral epiphyseal size (smaller on the affected side)
 apparent increased density of the femoral head epiphysis
 widening of the medial joint space
 blurring of the physeal plate
 radiolucency of the proximal metaphysis