What is the history of Legg-Calvé-Perthes disease?

Legg-Calvé-Perthes disease, also known as Perthes disease or avascular necrosis of the femoral head, is a childhood condition that affects the hip joint. It was first described by three different physicians independently, namely Arthur Legg in 1910, Jacques Calvé in 1911, and Georg Perthes in 1912. The disease primarily affects children between the ages of 4 and 10, with boys being more commonly affected than girls.

The history of Legg-Calvé-Perthes disease begins with the initial observations made by the three physicians who independently identified and described the condition. Arthur Legg, an American orthopedic surgeon, first reported a series of cases in 1910, describing a condition characterized by hip pain, limited range of motion, and eventual deformity of the femoral head. Shortly after, Jacques Calvé, a French surgeon, published similar findings in 1911, highlighting the importance of early diagnosis and treatment. In 1912, Georg Perthes, a German orthopedic surgeon, also independently described the disease, emphasizing the role of avascular necrosis in its pathogenesis.

Legg-Calvé-Perthes disease is characterized by the interruption of blood supply to the femoral head, leading to the death of bone tissue (avascular necrosis). This interruption of blood flow results in the collapse and deformity of the femoral head, leading to hip pain, limited mobility, and potential long-term complications. The exact cause of the disease remains unknown, but several theories have been proposed, including genetic factors, vascular abnormalities, and mechanical stress on the hip joint.

Over the years, advancements in medical imaging techniques, such as X-rays and magnetic resonance imaging (MRI), have greatly improved the diagnosis and understanding of Legg-Calvé-Perthes disease. These imaging modalities allow for the visualization of the femoral head and the assessment of its shape, size, and degree of deformity. Early diagnosis is crucial in managing the disease and preventing long-term complications.

Treatment strategies for Legg-Calvé-Perthes disease have evolved over time. In the early 20th century, treatment primarily focused on bed rest and immobilization of the affected hip joint. However, as our understanding of the disease progressed, more active treatment approaches were developed. The use of braces, traction, and physical therapy became common in the mid-20th century to maintain hip mobility and prevent deformity.

In the latter half of the 20th century, surgical interventions gained prominence in the management of Legg-Calvé-Perthes disease. Procedures such as femoral osteotomy, in which the femur is surgically repositioned to improve joint mechanics, became widely used. The goal of surgical interventions is to preserve the shape and function of the hip joint, allowing for better long-term outcomes.

Today, the treatment of Legg-Calvé-Perthes disease is individualized based on the age of the child, the stage of the disease, and the severity of symptoms. Non-surgical approaches, such as physical therapy and activity modification, are often recommended in the early stages. Surgical interventions may be considered in cases where conservative measures fail to alleviate symptoms or prevent deformity.

Research into the etiology, pathogenesis, and treatment of Legg-Calvé-Perthes disease continues to advance our understanding of this complex condition. Ongoing studies aim to identify genetic factors that may contribute to the disease, explore the role of vascular abnormalities, and develop novel treatment strategies. The ultimate goal is to improve outcomes for children affected by Legg-Calvé-Perthes disease and minimize long-term complications.