title: Pathophysiology and new strategies for the treatment of Legg-Calvé-Perthes disease.
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.
authors.affiliation: 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, USA. Harry.kim@tsrh.org
authors.forename: Harry K W
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000818:Animals; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005270:Femur Head / Q000473:pathology* / Q000503:physiopathology; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007275:Injections, Intravenous; D007873:Legg-Calve-Perthes Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000077211:Zoledronic Acid
chemical_list: D019485:Bone Morphogenetic Proteins; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid