Legg-Calvé-Perthes disease – Surgical Treatment Options

Archives of Orthopaedic and Trauma Surgery (2025) 145:186
https://doi.org/10.1007/s00402-025-05801-3

Sebastian Braun (1) · Stefanie Adolf (2) · Marco Brenneis (2) · Friedrich Boettner (3) · Andrea Meurer (4)

1 Charité – University Medicine Berlin, Berlin, Germany
2 St. Josefs Hospital, Wiesbaden, Germany
3 Hospital for Special Surgery, New York, USA
4 Medical Park Klinik, Bad Wiessee, Germany

Abstract

Legg-Calvé-Perthes disease (LCPD), is a rare avascular osteonecrosis of the proximal femur usually occurring in children between 5 and 10 years of age. The cause of ischemia leading to necrosis of the femoral head remains unknown. The goal of surgical treatment for LCPD is to improve the containment of the femoral head to restore the function of the hip joint and prevent further damage to the femoral head leading to premature hip osteoarthritis. Although a causal therapy is not available, the main aim is to maintain or restore the containment of the affected hip joint. The specific surgical treatment depends on the patient’s age at onset, the stage, and severity of the disease. In early stages of the disease, the most common surgical option is a containment-restoring procedure such as femoral varus osteotomy (FVO), Salter’s innominate osteotomy (SIO), and triple pelvic osteotomy (TPO). Moderate forms of LCPD show good results after treatment with either FVO or SIO, severe cases are recommended to be treated with FVO combined with either SIO or TPO to provide good outcomes. In later stages with increased damage to the femoral head, surgical options may include non-containment-restoring procedures to help symptom relief or restore anatomical and biomechanical features to a certain extend e.g., femoral valgus extension osteotomy or trochanter apophyseodesis. Due to the complexity of surgical interventions and the challenging nature of LCPD it is essential to consult with an experienced surgeon in pediatric orthopedics to determine the best treatment course for the patient.

Introduction

More than a century after its initial description in 1910, Legg-Calvé -Perthes disease (LCPD) continues to raise many questions. Following hip dysplasia, LCPD is the most common disease of the hip joint in childhood [1]. It is an avascular osteonecrosis of the proximal femoral epiphysis and a subsequent ossification disorder in children with skeletal immaturity [2]. LCPD is the most common osteonecrosis in children. The cause is still unknown, but various pathogenetic factors are discussed [3]. Clinical signs of the disease are hip as well as knee pain, reluctance to move, and limited range of motion, especially in abduction and internal rotation of the hip joint [4]. The disease is self-limiting and progresses in defined stages over a period 2–5 years. Although a causal therapy is not available, the aim of current therapeutic approaches is to increase (or maintain a good) range of motion, to preserve the femoral head, to limit mechanical stress on the hip joint and eventually to restore the containment surgically in order to reduce the risk of early hip osteoarthritis (OA) [5]. During progression of LCPD, patience and discipline regarding the individual therapy is required from the young patients, their families and therapists. In this review we will present a brief overview of important characteristics of the disease, followed by a description of the different established surgical treatment options. Today’s surgical procedures can be divided into containment-restoring and non-containment restoring procedures. The containment-restoring procedures include femoral varus osteotomy (FVO), Salter’s innominate osteotomy (SIO), triple pelvic osteotomy (TPO), periacetabular osteotomy (PAO) and head reduction osteotomies (FHRO). In more severe cases, where containment restoring options are no longer recommended, surgeons might have to resort to non-containment-restoring procedures for symptom improvement, such as Morscher’s femoral neck lengthening osteotomy, trochanter apophyseodesis or total hip arthroplasty (THA) for skeletally mature deformities.

…