Developing medical therapy for legg-calvé- perthes’ disease

Legg-Calvé-Perthes’ disease (LCPD) was recognized as a separate disease entity from tuberculosis over 100 years ago by Drs. Legg from the USA [1], Calvé from France [2], and Perthes from Germany [3]. Despite research efforts to improve the knowledge base for this pediatric idiopathic hip disorder, LCPD remains one of the most controversial conditions in pediatric orthopedics. While two prospective multicenter studies [4, 5], meta-analyses [6, 7], and some large retrospective studies [8–10] provide clinically valuable information about the outcomes of current operative and nonoperative treatments for LCPD, the optimal way to treat this condition remains elusive. These studies show that the success rates of current treatments, including a femoral varus osteotomy and the Salter innominate osteotomy, in producing a round femoral head (Stulberg I or II hips) range from 40 to 60 % [4, 5] in those children with the onset of the disease after age 8. These results point to the clinical need to develop more effective treatments including biological treatments to specifically target the pathological processes contributing to the femoral head deformity and the poor bone healing. This chapter discusses the experimental evidence for using bisphosphonate therapy to treat LCPD and the potential limitations of bisphosphonate therapy.