Which condition presents with a persistent limp and hip symptoms during early school age and is associated with avascular necrosis of the femoral head?

Which condition presents with a persistent limp and hip symptoms during early school age and is associated with avascular necrosis of the femoral head?

• A. Slipped Capital Femoral Epiphysis
• B. Legg-Calve-Perthes Disease
• C. Transient Synovitis
• D. Osgood-Schlatter Disease

Answer: (B)

Legg-Calvé-Perthes disease is being tested here. In children, typically around ages 4 to 8, a persistent limp with hip or knee pain that develops gradually points to an ischemic event in the femoral head. This condition is due to avascular necrosis of the femoral head, meaning the blood supply to the head of the thigh bone is temporarily disrupted. Over time the femoral head can become flattened or deformed, which can lead to ongoing limited hip motion, especially internal rotation and abduction, and a limp that may be worse with activity. Understanding the age pattern helps distinguish it from other common pediatric hip conditions. Slipped capital femoral epiphysis tends to occur in adolescents, often with rapid growth and sometimes obesity, and presents with hip or knee pain plus a limp but without an ischemic femoral head lesion. Transient synovitis can cause hip pain and a limp too, but it usually has a more acute onset with systemic signs and resolves in a short period, without AVN risk. Osgood-Schlatter disease causes knee pain from tibial tubercle traction and does not involve the hip or AVN. Recognizing Legg-Calvé-Perthes disease early is important to guide management—often involving activity modification and containment of the femoral head, with more advanced interventions reserved for those with ongoing deformity or limited motion—to reduce the risk of long-term hip problems.

Legg-Calvé-Perthes disease is being tested here. In children, typically around ages 4 to 8, a persistent limp with hip or knee pain that develops gradually points to an ischemic event in the femoral head. This condition is due to avascular necrosis of the femoral head, meaning the blood supply to the head of the thigh bone is temporarily disrupted. Over time the femoral head can become flattened or deformed, which can lead to ongoing limited hip motion, especially internal rotation and abduction, and a limp that may be worse with activity.

Understanding the age pattern helps distinguish it from other common pediatric hip conditions. Slipped capital femoral epiphysis tends to occur in adolescents, often with rapid growth and sometimes obesity, and presents with hip or knee pain plus a limp but without an ischemic femoral head lesion. Transient synovitis can cause hip pain and a limp too, but it usually has a more acute onset with systemic signs and resolves in a short period, without AVN risk. Osgood-Schlatter disease causes knee pain from tibial tubercle traction and does not involve the hip or AVN.

Recognizing Legg-Calvé-Perthes disease early is important to guide management—often involving activity modification and containment of the femoral head, with more advanced interventions reserved for those with ongoing deformity or limited motion—to reduce the risk of long-term hip problems.