Access Keys:
Skip to content (Access Key - 0)

Legg-Calve-Perthes syndrome


This is a condition that is characterized by loss of blood supply to the capital femoral epiphysis.


Describe the pertinent anatomy and provide links to relevant pages


Describe the biologic basis of the disorder or the mechanism of injury

Natural History

The disease goes through various stages, which include,  stage of synovitis, stage of fragmentation, stage of reossification and remodelling.

Patient History and Physical Findings

AGE: THe usual age at onset is 4-8 years 

GENDER: Boys are more commonly affected than girls.

BILATERALITY: Bilateral involvement may be seen in approximately 20% of cases. Radiographic evidence of bilateral "Perthes" like changes should raise the suspicion for Multiple, epiphyseal dysplasia, Gaucher's Disease, Sickle cell disease and Hypothyroidism.


The usual presentation is hip pain and or limping.


There is restriction of hip motion- most often internal rotation and abduction on the affected side. There may be a hip flexion contracture as demonstrated by the Thomas' test. Affected children will usually walk with an antalgic gait.

Imaging and Diagnostic Studies

Radiographs may be negative in the early stages. MR imaging demonstrates avascular changes well before changes are seen on plain films. Bone scan has extensively been used in the diagnosis and prognostication of Perthes disease.

Plain films should include antero-posterior and frog-leg lateral views. The earliest sign on plain films is the Waldenstrom sign with increase in the medial clear space. With further involvement there may be a crescent sign noted (more obvious on the frog leg lateral) which is indicative of a subchondral fracture. The Salter-Thompson classification is based on the extent of the crescent sign (Salter Thompson A: less than 50% involvement and Salter-Thompson B : crescent extends more than 50% across the head).

Stage of Fragmentation: In this stage there is progressive sclerosis and flattening of the capital femoral epiphysis.

Figure: Perthes coxa-breva

Differential Diagnosis

Transient synovitis (Toxic synovitis)

Infection: Tuberculosis, Lyme disease

Sickle Cell disease

Multiple epiphyseal dysplasia


Medical therapy
Nonoperative treatment
Operative treatment - include links to pages with detailed surgical techniques
Indications and contraindications

Pearls and Pitfalls

Tips and problems to avoid

Postoperative Care

Include immediate postoperative care and rehabilitation


  • Residual proximal femoral deformities, including:
    • Coxa breva
    • Coxa magna
    • Coxa plana
  • Many go on to develop degenerative hip disease


Include overview of complications

Selected References

Insert selected references and landmark articles

Peer Review

OrthopaedicsOne Peer Review Workflow is an innovative platform that allows the process of peer review to occur right within an OrthopaedicsOne article in an open, transparent and flexible manner. Learn more

Instructions for Authors

Read our Instructions for Authors to learn about contributing or editing articles on OrthopaedicsOne.

Content Partner

Learn about becoming an OrthopaedicsOne Content Partner.

Academic Resources

Resources on Legg-Calve-Perthes syndrome from Pubget.

The license could not be verified: License Certificate has expired!
Orthopaedic Web Links

Internet resources validated by

The license could not be verified: License Certificate has expired!
Related Content

Resources on Legg-Calve-Perthes syndrome and related topics in OrthopaedicsOne spaces.

Page: Slipped capital femoral epiphysis (SCFE) (OrthopaedicsOne Articles)
Page: Legg-Calve-Perthes syndrome (OrthopaedicsOne Articles)
Page: Congenital muscular dystrophy (OrthopaedicsOne Articles)
Page: Congenital myopathies (OrthopaedicsOne Articles)
Page: Congenital vertical talus (OrthopaedicsOne Articles)
Page: Coxa vara (OrthopaedicsOne Articles)
Page: Curly toes (OrthopaedicsOne Articles)
Page: Developmental milestones (OrthopaedicsOne Articles)
Page: Down's syndrome (OrthopaedicsOne Articles)
Page: Ehlers-Danlos syndrome (OrthopaedicsOne Articles)
Showing first 10 of 378 results