Waldenström, Acta Radiol 1922 - The Definite Form of the Coxa Plana

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The Definite Form of the Coxa Plana

Waldenström·Acta Radiol·1922·48 citations·Case series

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Waldenström's 1922 paper describes coxa plana (Legg-Calvé-Perthes disease), the term he coined in 1920 for characteristic flattening of the caput, collum, and acetabulum. He follows children from disease onset through skeletal maturity to define the healed 'definite form.' He classifies the residual deformity into three severity groups.

Key Findings

Waldenström followed 37 cases (42 hips), of which 22 hips were tracked from onset to skeletal maturity. This long-term cohort let him define what the healed hip actually looks like, rather than guessing the endpoint from single snapshots.
He staged the disease into an evolutionary period (initial then fragmentation), a healing period, a growth period, and a definite stage. The definite form is usually reached after the disease has existed 4-6 years, and these stages remain the conceptual basis for modern Perthes staging.
He divided the healed 'definite form' into three severity groups:
- Group 1 (ordinary): rounded caput, distinct from collum and trochanter — 14 of 22 hips
- Group 2: enlarged anterosuperior caput overlying the trochanter, no visible upper collum — 6 hips
- Group 3 (most severe): uneven, excavated joint surface, sharp-edged upper pole — 3 hips
The healed deformity is stable and does not change once reached, confirmed by cases followed 10-13 years with no change in form. Milder deformities become definite early; the most severe reach final form only late in the growth period.
He established the disease is not inflammatory or infectious, correcting the misleading label 'osteochondritis deformans.' The diagnosis of coxa plana essentialis can be made with certainty only during the evolutionary stage.
Treatment (rest, extension, immobilization) did not alter the course. Waldenström noted the disease develops in a 'typical and presumably predestined manner whatever one does.'
Function was often preserved despite severe deformity. One patient with bilateral maximal deformity retained only flexion yet could play football, cycle, and dance.
The residual deformity predisposes to secondary arthritis, with patients presenting around age 50 with hip pain resembling arthritis deformans, because part of the head never participates in articulation.

Board PearlWaldenström defined coxa plana (Perthes) as a non-inflammatory disease that flattens the entire hip joint, staged from fragmentation through healing to a definite deformity.

The Definite Form of the Coxa Plana

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The Definite Form of the Coxa Plana

Waldenström·Acta Radiol·1922·48 citations·Case series

|

Waldenström's 1922 paper describes coxa plana (Legg-Calvé-Perthes disease), the term he coined in 1920 for characteristic flattening of the caput, collum, and acetabulum. He follows children from disease onset through skeletal maturity to define the healed 'definite form.' He classifies the residual deformity into three severity groups.

Key Findings

Waldenström followed 37 cases (42 hips), of which 22 hips were tracked from onset to skeletal maturity. This long-term cohort let him define what the healed hip actually looks like, rather than guessing the endpoint from single snapshots.
He staged the disease into an evolutionary period (initial then fragmentation), a healing period, a growth period, and a definite stage. The definite form is usually reached after the disease has existed 4-6 years, and these stages remain the conceptual basis for modern Perthes staging.
He divided the healed 'definite form' into three severity groups:
- Group 1 (ordinary): rounded caput, distinct from collum and trochanter — 14 of 22 hips
- Group 2: enlarged anterosuperior caput overlying the trochanter, no visible upper collum — 6 hips
- Group 3 (most severe): uneven, excavated joint surface, sharp-edged upper pole — 3 hips
The healed deformity is stable and does not change once reached, confirmed by cases followed 10-13 years with no change in form. Milder deformities become definite early; the most severe reach final form only late in the growth period.
He established the disease is not inflammatory or infectious, correcting the misleading label 'osteochondritis deformans.' The diagnosis of coxa plana essentialis can be made with certainty only during the evolutionary stage.
Treatment (rest, extension, immobilization) did not alter the course. Waldenström noted the disease develops in a 'typical and presumably predestined manner whatever one does.'
Function was often preserved despite severe deformity. One patient with bilateral maximal deformity retained only flexion yet could play football, cycle, and dance.
The residual deformity predisposes to secondary arthritis, with patients presenting around age 50 with hip pain resembling arthritis deformans, because part of the head never participates in articulation.

Board PearlWaldenström defined coxa plana (Perthes) as a non-inflammatory disease that flattens the entire hip joint, staged from fragmentation through healing to a definite deformity.

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