Recurrent Legg-Perthes-Calvé disease

SummaryIntroductionLegg-Perthes-Calvé disease (LPC), or primitive hip osteochondritis, is a frequent pathology but in which recurrence is extremely rare.We reportThe case of a girl diagnosed with bilateral LPC at the age of 4.5 years. Containment in a Scottish-Rite (Atlanta) brace was prescribed. X-ray follow-up found complete right-hip healing at 1.5 years’ evolution (Catterall group 2). The patient was seen again at the age of 8 years, for limp and functional disorder associated with recurrence of right-hip LPC (Catterall group 3). Evolution was satisfactory: the girl was assessed at the time of bone maturity, with good clinical and radiological findings.DiscussionChildren contracting LPC are commonly thought to be thereby “vaccinated” against it. This is wrong, and a literature search found 10 cases similar to the present one, making 11 children in all (two girls, nine boys) presenting with recurrent LPC. Mean age at initial onset was 4 years (range, 2.5–6 yrs). Five of the 11 had initially been presented with bilateral LPC. Mean age at recurrence was 9.4 years (range, 6–12 yrs). The recurrences were more severe than the initial episodes, but final prognosis after recurrence would not seem to be worse than normal.ConclusionThis exceptional case of recurrent LPC was well documented up to bone maturity. It does not support the notion of Meyer's disease at the initial episode, as suggested by certain authors, but rather that of true recurrence of the primitive LPC.