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Current Concepts Review   |    
Pathophysiology and New Strategies for the Treatment of Legg-Calvé-Perthes Disease
Harry K.W. Kim, MD, MS, FRCSC1
1 Center for Excellence in Hip Disorders, Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, 2222 Welborn Street, Dallas, TX 75218. E-mail address: Harry.kim@tsrh.org
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Investigation performed at Texas Scottish Rite Hospital for Children, Dallas, Texas



Disclosure: The author did not receive payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. Neither the author nor his institution has had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. The author has had a relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Apr 04;94(7):659-669. doi: 10.2106/JBJS.J.01834
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Abstract

Legg-Calvé-Perthes disease is a juvenile form of idiopathic osteonecrosis of the femoral head that can lead to permanent femoral head deformity and premature osteoarthritis.

According to two recent multicenter, prospective cohort studies, current nonoperative and operative treatments have modest success rates of producing a good outcome with a spherical femoral head in older children with Legg-Calvé-Perthes disease.

Experimental studies have revealed that the immature femoral head is mechanically weakened following ischemic necrosis.

Increased bone resorption and delayed new bone formation, in combination with continued mechanical loading of the hip, contribute to the pathogenesis of the femoral head deformity.

Biological treatment strategies to improve the healing process by decreasing bone resorption and stimulating bone formation appear promising in nonhuman preclinical studies.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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