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Table 1 LCPD stages

From: Legg–Calvé–Perthes disease overview

Stage

Characteristics

Initial or necrosis phase

Interruption of vascular supply and bone necrosis, at this stage the FH is very vulnerable to the forces acting on it; radiologically the Waldenström sign is visible, which is characterized by increased joint space, secondary to a subchondral fracture, this is the earliest radiological sign

Fragmentation phase

It is initiated by a process of resorption of necrotic bone, radiologically dense bone islets appear, the central ones are condensed, and the lateral ones undergo osteolysis producing an image with multiple lines

Reossification phase

The density is displaced in the opposite direction, the epiphysis is invaded by vessels, the dense islets are reabsorbed and irregular bone tissue is formed, which then trabeculates, and repair begins with disappearance of the metaphyseal osteolysis

Final phase, of healing or residual deformity

The necrotic bone is completely replaced by newly formed bone. The newly formed bone has a lower rigidity so it can be remodeled in such a way that the morphology of the FH adapts to the shape of the insertion hole or not, this process will not be definitive until the end of bone maturation. The result may be a deformed FH

  1. This table includes information from the following references
  2. Kim HK, Herring JA. Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am 2011;42(3):285–95
  3. Wenger DR, Pandya NK. A brief history of Legg–Calvé–Perthes disease. J Pediatr Orthop 2011;31(2)130–136
  4. Dustmann HO. [Etiology and pathogenesis of epiphyseal necrosis in childhood as exemplified with the hip]. Z Orthop Ihre Grenzgeb. 1996 Sep-Oct;134(5):407–12
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Orphanet Journal of Rare Diseases

ISSN: 1750-1172