This 2016 JBJS Reviews article comprehensively covers the pathogenesis, classification systems, natural history, and operative versus nonoperative treatment options for Legg-Calvé-Perthes disease, synthesizing evidence from animal models, multicenter prospective cohorts, and meta-analyses to address the central question of whether and when surgical containment improves femoral head sphericity.
When you see a child over age 6–8 with lateral pillar B or B/C LCP disease in the early fragmentation stage, early operative containment (femoral varus or Salter innominate osteotomy) offers a statistically superior chance of a spherical femoral head at maturity — but counsel families that only 1 in 6–7 surgically treated patients gains a spherical head they would not have had otherwise, and that anything short of Stulberg I or II carries a high long-term OA risk.
This 2016 JBJS Reviews article comprehensively covers the pathogenesis, classification systems, natural history, and operative versus nonoperative treatment options for Legg-Calvé-Perthes disease, synthesizing evidence from animal models, multicenter prospective cohorts, and meta-analyses to address the central question of whether and when surgical containment improves femoral head sphericity.
When you see a child over age 6–8 with lateral pillar B or B/C LCP disease in the early fragmentation stage, early operative containment (femoral varus or Salter innominate osteotomy) offers a statistically superior chance of a spherical femoral head at maturity — but counsel families that only 1 in 6–7 surgically treated patients gains a spherical head they would not have had otherwise, and that anything short of Stulberg I or II carries a high long-term OA risk.