Legg-Calvé-Perthes disease and altitude: A hypothesis-generating narrative minireview

Legg-Calvé-Perthes disease (LCPD) is a pediatric orthopaedic condition with unclear etiology.While previous studies have linked the disease to inflammatory and hypercoagulable states, genetic predisposition, and socioeconomic factors, the variability of incidence across regions with similar latitudes remains unexplained.This hypothesisgenerating narrative minireview aimed to analyze a possible association between altitude and the incidence of LCPD by reviewing the literature on environmental influences and analyzing topographic data from previously reported incidence maps.A narrative literature review was conducted through PubMed, Scopus, Web of Science and EMBASE, with no language or date restrictions, using search terms related to LCPD, altitude, inflammation, and hypoxia.Articles were selected based on relevance and quality of information.Regional comparisons within the United Kingdom appear to align with this hypothesis, indicating a tendency toward a higher incidence (approximately 40% higher) of LCPD in elevated areas of similar latitude and socioeconomic status, potentially through mechanisms involving tissue hypoxia and proinflammatory cascades, although potential environmental confounders were not fully controlled.Although no causal relationship can be established, the hypothesis that altitude contributes to LCPD incidence deserves further investigation, including the execution of multi-site epidemiological evaluations and experimental validation in animal models across highaltitude settings.