Legg-Calvé-Perthes disease has been recognized for more than 100 years. It is an idiopathic osteonecrosis of the femoral head in children that follows a predictable course of bone death, revascularization, bone resorption, and eventually reossification and bone healing. The natural history is often favorable for children younger than 6 years and poor for children older than 8 to 10 years. The final outcome is determined by the shape of the healed femoral head and its congruence with the acetabulum. Treatment is aimed at preserving range of motion, maintaining containment, and limiting mechanical damage to the femoral head. Nonsurgical interventions include restricted weight-bearing, range of motion exercises, and casting or bracing treatment. Surgical interventions include osteotomies of the femur or pelvis or both to maintain containment, as well as joint distraction for containment and decreasing mechanical force. Superiority of a particular treatment strategy has been difficult to demonstrate due to relative rarity of the condition, variable natural history, and long-time horizon to predict final outcome. Recent research has focused on better imaging predictors and understanding and altering the pathophysiology subsequent to the vascular disturbance.
Gilbert et al. (2025) studied this question.