Keywords
Osteotomy
Prognosis
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Abstract
Objective: To analyze the main aspects related to the diagnosis and treatment of Legg-Calvé-Perthes disease in the pediatric population. Methods: This was an integrative literature review with a descriptive and qualitative approach, conducted in the PubMed, LILACS, and SciELO databases. The guiding question, based on the PICo strategy, investigated which diagnostic and therapeutic factors should be considered to define the most appropriate management for children with the disease. Articles published between 2020 and 2025, available in full text, in Portuguese, English, or Spanish, were included. In total, 19 studies composed the final sample. Results: Most studies focused on comparisons between conservative management and surgical containment procedures, as well as on the evaluation of early prognostic markers. The acetabular-femoral head match index, medial joint space widening, and diffuse metaphyseal reactions were useful for the early identification of structural risk. In late-onset patients, flexion varus osteotomy showed more favorable radiographic outcomes. Final considerations: Decision-making should consider age at diagnosis, disease stage, degree of subluxation, early prognostic markers, and the possibility of longitudinal follow-up.
References
AL-OSAIMI MN, et al. Management of patients with Legg-Calvé-Perthes disease at a single center in Jeddah, Saudi Arabia. Cureus, 2022; 14(6).
BRAUN S, et al. Legg-Calvé-Perthes disease: surgical treatment options. Archives of Orthopaedic and Trauma Surgery, 2025; 145(1).
CORDEIRO FG, et al. Reproducibility of modified Waldenström classification in Perthes disease. Acta Ortopédica Brasileira, 2021; 29(2): 92-96.
DEMIREL M, et al. Radiographic and functional outcomes of shelf acetabuloplasty versus conservative management in Legg-Calvé-Perthes disease: an age- and gender-matched study including healthy controls for isokinetic hip muscle strength. International Orthopaedics, 2025; 49(9): 2181-2194.
DEO NB, AGARWAL A. O acetábulo sofre remodelamento após a osteotomia derrotatória varizante em pacientes com doença de Perthes? Revista Brasileira de Ortopedia, 2023; 58(4): e639-e645.
DO DH, et al. Weightbearing and activity restriction treatments and quality of life in patients with Perthes disease. Clinical Orthopaedics and Related Research, 2021; 479(6): 1360-1370.
DUJARDIN R, et al. Radiographic study of the medial joint space of the hip in Legg-Calvé-Perthes disease. Acta Ortopédica Brasileira, 2022; 30(6): e256112.
GAHLEITNER M, et al. Foam splint: the comfortable way of postoperative immobilization after surgical hip reconstruction in children: a randomized clinical trial. Journal of Clinical Medicine, 2025; 14(10): 3485.
GALLOWAY AM, et al. Clinical consensus recommendations for the non-surgical treatment of children with Perthes’ disease in the UK. The Bone & Joint Journal, 2024; 106-B(5): 501-507.
GOYAL T, et al. Hip arthroscopy for sequelae of Legg-Calvé-Perthes disease: a systematic review. Hip & Pelvis, 2021; 33(1): 3-10.
JOSEPH B, et al. Epidemiology, natural evolution, pathogenesis, clinical spectrum, and management of Legg-Calvé-Perthes disease. Journal of Children’s Orthopaedics, 2023; 17(5): 385-403.
LEIBOLD CS, et al. Development of acetabular retroversion in LCPD hips: an observational radiographic study from early stage to healing. Archives of Orthopaedic and Trauma Surgery, 2022; 143(7): 3945-3956.
LEO DG, et al. The outcomes of Perthes’ disease: development of a core outcomes set for clinical trials in Perthes’ disease. The Bone & Joint Journal, 2020; 102-B(5): 611-617.
LI Z, et al. Prognostic significance of metaphyseal changes in Legg-Calvé-Perthes disease. Journal of Pediatric Orthopedics, 2025; 45(9): e818-e825.
MALEKI A, et al. Surgical treatments for Legg-Calvé-Perthes disease: comprehensive review. Interactive Journal of Medical Research, 2021; 10(2): e27075.
NAKAMURA T, et al. Does flexion varus osteotomy improve radiographic findings compared with patients treated in a brace for late-onset Legg-Calvé-Perthes disease? Clinical Orthopaedics and Related Research, 2023; 481(4): 808-819.
PERRY DC, et al. The British Orthopaedic Surgery Surveillance study: Perthes’ disease. The Bone & Joint Journal, 2022; 104-B(4): 510-518.
PISECKY L, et al. Foam splint versus spica cast: early mobilization after hip reconstructive surgery in children: preliminary data from a prospective randomized clinical trial. Children, 2022; 9(2): 288.
PISECKY L, et al. Progressive lateralization and constant hip geometry in children with DDH, NDH, and LCPD following hip reconstructive surgery: a cohort study of 73 patients with a mean follow-up of 4.9 years. Archives of Orthopaedic and Trauma Surgery, 2023; 143(3): 1193-1202.
RODRÍGUEZ-OLIVAS AO, et al. Legg-Calvé-Perthes disease overview. Orphanet Journal of Rare Diseases, 2022; 17(1): 125.
SOUZA MT, et al. Revisão integrativa: o que é e como fazer. Einstein, 2010; 8(1): 102-106.
TUKTIYEVA N, et al. The treatment of Legg-Calve-Perthes disease in children: comparative effectiveness of the method of hardware unloading and the method of tunnelization of the femoral head and neck. La Clinica Terapeutica, 2025; 176(4): 427-435.
WADSTRÖM MG, et al. Demographics and risk for containment surgery in patients with unilateral Legg-Calvé-Perthes disease: a national population-based cohort study of 309 patients from the Swedish Pediatric Orthopedic Quality Register. Acta Orthopaedica, 2024; 95: 333-339.
ZHAO D, et al. Legg-Calvé-Perthes disease: diagnostic value of acetabular-femoral head match index. Scientific Reports, 2024; 14(1).