Functional and radiological outcomes of management of Legg–Calvé–Perthes disease: A retrospective and prospective observational study

A bstract Background: Legg–Calvé–Perthes disease (LCPD) is an idiopathic pediatric hip disorder characterized by avascular necrosis of the femoral head. Aim: The principal aim of management is containment of the femoral head within the acetabulum to preserve sphericity; however, the optimal modality remains debated, particularly in late-presenting cases prevalent in the Indian subcontinent. Materials and Methods: This retrospective–prospective observational study was conducted at a tertiary care center between January 2018 and May 2025. Forty patients (42 hips) aged 3–12 years with LCPD were included—25 retrospectively and 15 prospectively. Clinical outcomes were assessed using the Harris Hip Score (HHS). Radiological outcomes were evaluated using the Modified Elizabethtown, Herring lateral pillar, and Stulberg classifications, as well as quantitative indices such as sphericity deviation score, acetabular index (AI), center-edge angle (CEA), and neck-shaft angle (NSA). Management strategies included conservative care, varus derotation osteotomy (VDRO), and shelf acetabuloplasty, tailored according to age, stage, and lateral pillar involvement. Results: The mean age at presentation was 7.7 years; 85% were male, and 10% had bilateral involvement. Pain and limp were the most common presenting complaints. At healing, mean HHS improved across all modalities: conservative (89.7), VDRO (90.6), and shelf acetabuloplasty (84.9). Radiologically, VDRO corrected NSA (141.6° → 128.6°), shelf acetabuloplasty improved AI (19.9° → 13.6°), and CEA (18.9° → 30.6°), while conservative treatment preserved function but allowed progressive extrusion. Final Stulberg outcomes were good (I–II) in 61.8%, fair (III) in 26.5%, and poor (IV–V) in 11.7%. Complications were minimal. Conclusion: The mean age at presentation was 7.7 years; 85% were male, and 10% had bilateral involvement. Pain and limp were the most common presenting complaints. At healing, mean HHS improved across all modalities: conservative (89.7), VDRO (90.6), and shelf acetabuloplasty (84.9). Radiologically, in VDRO, an average of 13° of varus was achieved in NSA (141.6° → 128.6°), shelf acetabuloplasty improved AI (19.9° → 13.6°), and CEA (18.9° → 30.6°), while conservative treatment preserved function but allowed progressive extrusion. Final Stulberg outcomes were good (I–II) in 61.8%, fair (III) in 26.5%, and poor (IV–V) in 11.7%. Complications were minimal.