LCPD – Legg Calve Perthes

.L. Copeliovitch M.D

Assaf Harofe Medical Center
Legg Calve Perthes - LCPD
?LCPD – What Is the Disease
LCPD - Etiology
 Synovitis
 Trauma, hyperactive child
 Delayed bone age
 Thrombofilic state(Glueck): protein C,
protein S, lipoprotein A
 Vascular anomaly
 Inoue:AVN after sequential isquemia (dogs)
LCPD – Ischemic Insult
LCPD – Disease Process
LCPD - Epidemiology
 Incidence: 1/20,000
Under 15y: 1/1200
 Age:2y to adolescence, peak 4 to 8 years

 Sex: Male>Female, 4:1

LCPD - Association
 Classic candidate: small hyperactive inner
city boy!
 Race: more frequent in Caucasians

 Site: Left>Right

Bilateral in 15%
.LCPD – Waldenstrom classif
LCPD – Clinical Features
 Pain
 Limp
 Limitation of hip motion
 Trendelenburg gait
 Delayed bone age
LCPD – Differential Diagnosis
 Infection
 Transient Synovitis
 Trauma
 Tumors
 SCFE
 Hypothyroidism
 Spondyloepiphyseal dysplasia
LCPD – Deformity Process
LCPD – Conservative Treatment
LCPD – Treatment Concepts
 Maintain ROM
 Under age 6y: usually no treatment or
conservative
 Symptomatic: rest, NSAID,diminish
activities,partial weight bearing
 Containment: conservative, surgical
 Distraction
LCPD - Traction
LCPD – Containment Movement
LCPD – Final Shape
LCPD – Hinge Abduction
LCPD – Saddle Shape
Saddle Shape Movement
Mose Outcome Classification
 LCPD – Petrie broomstick POP
 Mose good in 60%: Petrie-1971
LCPD - Braces
”LCPD – Atlanta ”Scottish Rite
LCPD – Unilateral Brace-
Birmingham
LCPD – Bilateral Brace
LCPD – Bicycle Containment
LCPD – Bike and Brace
Surgical Containment – A. Axer
Femoral Varus Osteotomy
Shelf Operation
Salter Operation