Juvenile osteochondrosis of hip and pelvis
ICD-10 M91.8 ICD-11 FB82.1.3

Treatment of Juvenile Osteochondrosis of Hip in Children Under 8 with Preserved Joint Containment

Clinical Scenario

This protocol addresses children with juvenile osteochondrosis of the hip and pelvis (Legg-Calvé-Perthes disease) whose skeletal age is less than 8 years, who retain preserved hip joint containment confirmed by joint congruence on radiographic imaging, and who demonstrate good hip range of motion.

Defining Features of This Presentation

When hip mobility is preserved and radiographic imaging confirms joint congruence with the epiphysis centred within the acetabular cup, conservative therapy represents the first-line approach. In children with a skeletal age below 8 years, the revalgization potential of the proximal femur is considered sufficient to inform the surgical strategy when operative intervention is indicated.

The surgical approach for this presentation involves osteotomy of the proximal femur — and in cases where advanced containment of the hip joint is required, this may be combined with a pelvic procedure targeting the acetabular component.

The complete operative sequence, indications, and decision pathway are detailed in the full protocol →
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References

  1. In the initial phase of LCPD, when hip mobility is preserved and radiographic imaging confirms joint congruence with the epiphysis centered within the acetabular cup, conservative therapy remains the first-line treatment approach.
  2. If the skeletal age is less than 8 years, solely FVO is possible due to the sufficient revalgization potential.
  3. In cases of severe decentration and secondary acetabular involvement, the FVO can be combined with a pelvic redirection osteotomy in the sense of 'advanced containment'.
  4. Better covering of the anterolateral portion of the femoral head can be achieved with the SIO.
DOI: 10.1007/s00402-025-05801-3
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