50 Years Ago in CORR: Legg-Calvé-Perthes syndrome (LCPS): An up-to-date critical review Charles W. Goff, MD CORR 1962;22:93–107

Three independent seminal papers published in 1911 by Arthur Legg [9, 10], Jacque Calve [3, 4], and Georg Perthes [12, 13] described what we now know as “Legg-Calve-Perthes disease” (LCPD) and distinguished the entity from other forms of a deforming arthritis that affected children. At that time, arthritis deformans (as it was frequently known) was sometimes not recognized until adolescence and young adulthood. Others [1, 2, 11, 14] had earlier described the entity but had not so clearly distinguished it from other disorders, particularly tuberculosis of the hip. (The earliest apparent descriptions by Baker [2] and Wright [14] appear as brief notes for the “Section of Diseases of Children” in the British Medical Journal.) By the mid 20th century, the entity was well known. Charles Weir Goff, in 1962, published in CORR a comprehensive review of the literature with 97 references, dating back to the earliest reference [6]. Goff summarized the then-known population genetics of LCPD. Today, researchers have found a variety of collagen-related genes that appear to play a role in the development of LCPD [5, 7, 8]. Initial recumbency, plus traction or splinting (by cast or brace) were the preferred methods of treatment at the time. Some surgeons recommended drilling or osteotomy to hasten healing, but Goff noted, “no controlled series (had) been reported…” and if he seemed skeptical he said, “The trend is toward early surgical simulation or revascularization of the upper femur.” The value of Goff’s review was its comprehensiveness and the tables (eg, Tables 1 and ​and4)4) that summarized relevant papers on each issue; the reader readily captures the array of treatments that were advocated at that time. Table 1 Table 4 Since Goff’s time, many researchers have identified risk factors (age at onset, “at risk” radiographic signs) that influence repair, subsequent growth, and development of the hip. Because the condition is self-limited (in the sense that the necrotic regions of the bone repair albeit sometimes with deformity), and most patients with the milder forms of the disease do well without surgery (at least for many decades), earlier nonoperative treatments, such as prolonged recumbency and bracing, have largely been abandoned. Nonetheless, treatment remains controversial. Most agree that children with symptoms (pain and limited motion) should be treated acutely by short-term bedrest and traction until the symptoms are relieved. Today, surgery during childhood is typically reserved for older children (over age 8) with more severe forms of the disease and hips at risk for deformities and subsequent osteoarthrosis. Since if untreated these children not infrequently require reconstructive surgery as young adults owing to early onset osteoarthrosis, the goal of surgery is generally to prevent or minimize the ultimate deformity. As in Goff’s day, we still lack controlled trials of the surgical options, and it remains unclear whether or to what degree these procedures delay the development of subsequent osteoarthrosis and the need for reconstruction.