Review Question - QID 106129

The patient in this vignette most likely has Legg-Calvé-Perthes disease (LCP) as evidenced by his age range (4-10 years) and characteristic presentation, most specifically the painless limp with pelvic muscle atrophy.

LCP is an ischemic disorder causing a flattening of the head of the femur and is typically a self limiting process that lasts <18 months. The timely diagnosis of LCP can be difficult, as it is initially asymptomatic but progresses with insidious onset of hip or knee pain and a painless limp. Physical exam findings include: shortening of the affected limb (asymmetry), hip stiffness and limited range of motion with reduced abduction and internal rotation, and atrophy of muscles in the upper thigh.

Adkins and Figler review hip pain in athletes. They report that LCP is typically seen in boys 4-10 years old and tends to occur in families. In contrast, transient synovitis of the hip is seen in the very young, slipped capital femoral epiphysis is seen most commonly in obese adolescent males, and femoral neck stress fractures are seen most commonly in adult athletes.

Nguyen et al. performed a meta-analysis of operative versus nonoperative treatments for LCP disease. They report that operative management in patients older than 6 years is more likely to yield a spherical congruent femoral head than nonoperative methods. Operative and nonoperative treatments in patients less than 6 years resulted in similar outcomes.

Illustration A shows a radiograph of a child with LCP of the left femur.

Incorrect Answers:
Answer 1: Hip dislocation would result from trauma and would result in a painful limp.
Answer 2: Septic arthritis would be more acute in onset than seen in this patient.
Answer 4: Transient synovitis of the hip would present with low grade fever and an abducted hip.
Answer 5: Slipped capital femoral epiphysis (SCFE) presents with a similar waddling gait, and decreased range of motion but is more common between the ages 11-15 and is often seen in obese children.