Pathophysiology and new strategies for the treatment of Legg-Calvé-Perthes disease

J Bone Joint Surg Am. 2012 Apr 4;94(7):659-69. doi: 10.2106/JBJS.J.01834.


Legg-Calvé-Perthes disease is a juvenile form of idiopathic osteonecrosis of the femoral head that can lead to permanent femoral head deformity and premature osteoarthritis. According to two recent multicenter, prospective cohort studies, current nonoperative and operative treatments have modest success rates of producing a good outcome with a spherical femoral head in older children with Legg-Calvé-Perthes disease. Experimental studies have revealed that the immature femoral head is mechanically weakened following ischemic necrosis. Increased bone resorption and delayed new bone formation, in combination with continued mechanical loading of the hip, contribute to the pathogenesis of the femoral head deformity. Biological treatment strategies to improve the healing process by decreasing bone resorption and stimulating bone formation appear promising in nonhuman preclinical studies.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adolescent
  • Age Factors
  • Animals
  • Bone Morphogenetic Proteins / therapeutic use*
  • Child
  • Cohort Studies
  • Combined Modality Therapy
  • Diphosphonates / therapeutic use*
  • Female
  • Femur Head / pathology*
  • Femur Head / physiopathology
  • Follow-Up Studies
  • Forecasting
  • Humans
  • Imidazoles / therapeutic use
  • Injections, Intravenous
  • Legg-Calve-Perthes Disease / diagnosis*
  • Legg-Calve-Perthes Disease / epidemiology
  • Legg-Calve-Perthes Disease / therapy*
  • Male
  • Orthopedic Procedures / methods
  • Physical Therapy Modalities
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome
  • Zoledronic Acid


  • Bone Morphogenetic Proteins
  • Diphosphonates
  • Imidazoles
  • Zoledronic Acid