Legg-Calvé-Perthes disease: the hidden destruction of the child’s hip - literature review

Background: Legg-Calvé-Perthes disease remains a significant challenge in pediatric orthopedics due to its unclear etiology, variable prognosis, and long-term risk of disabling hip deformities. Despite over a century since its first description, no consensus exists on optimal management. Recent studies have addressed epidemiology, genetics, imaging, and treatment, but evidence remains fragmented and sometimes contradictory. Objective: The aim of this review was to systematically evaluate the current state of scientific knowledge on Legg-Calvé-Perthes disease. The analysis covers epidemiology, pathogenesis, clinical presentation, diagnostic approaches, and classification systems. In addition, the review examines potential risk factors and possible causes of the disease, which remain incompletely defined despite extensive research. Particular attention is given to treatment strategies, highlighting the inconsistencies and lack of uniformity in current clinical practice. Methods: A comprehensive literature search was conducted in PubMed, Google Scholar, and Scopus, covering publications from January 2015 to April 2025. The review included original articles, systematic reviews, and meta-analyses, with inclusion criteria based on reliable research methodology, taking into account factors such as the characteristics of the study population, data collection methods, and approaches to data analysis. Publications that did not meet these criteria, were considered unreliable, or were based on outdated medical data were excluded from the review. A total of 50 articles were included. Results: Incidence varies across populations, and etiology is multifactorial, involving vascular, genetic, and hormonal mechanisms. Treatment approaches are inconsistent, with conservative management favored in younger children and surgical interventions in older or advanced cases. Conclusions: Legg-Calvé-Perthes disease remains a condition with an incompletely understood etiology, involving a multifactorial pathogenesis that includes genetic, environmental, metabolic, and hormonal factors. The complexity of LCPD's potential causes underscores the need for continued molecular, genetic, and clinical research, which could help to clarify the pathomechanisms of this condition. Treatment strategies remain heterogeneous and depend on patient age, disease stage, and institutional experience, with no consensus regarding the optimal timing or type of intervention. High-quality multicenter studies, including randomized controlled trials, are needed to reduce heterogeneity in clinical practice and to develop evidence-based recommendations.