Pain or Limp in a Pre-School-Aged Child: Consider Perthes Diagnosis and Orthopedic Referral
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objectives Legg-Calvé-Perthes Disease (LCPD) classically presents between 5–8 years of age; however, recent evidence suggests the highest incidence now occurs in children <6 years, including those <4. As a result, LCPD may not be considered in very young children, potentially delaying diagnosis and treatment. This study evaluates symptom duration, number of providers seen prior to diagnosis, and factors associated with time to diagnosis in young children with LCPD. Study Design Children with unilateral LCPD diagnosed before age 6 years (n=223) were identified from a prospective international multicenter database. Descriptive statistics, Spearman’s ρ, and multilevel gamma regression were used to assess associations between time to diagnosis and demographic and clinical variables. Results Median age at symptom onset was 4.2 years (IQR 3.3–4.9). Mean symptom duration prior to diagnosis was 4.0 (SD 4.8) months. Before presenting to an orthopedic surgeon, patients had seen a median of 2 providers (range 1–7), and 42% presented with late-stage disease. Limp (79%) and pain (71%) were the most common symptoms, with pain most frequently localized to the knee/thigh (31%) and hip/groin (27%). Regression analysis demonstrated a 13% decrease in time to diagnosis for each additional year of age, and a 16% increase in time to diagnosis for each additional provider consulted. Conclusions LCPD should be considered in pre-school–aged children presenting with limp or pain, including knee or thigh pain, to facilitate earlier referral and reduce late-stage presentation. Limitations include caregiver recall bias and limited detail on pain characteristics in the dataset.
Authors: Susan A. Novotny, Rachel Y. Goldstein, Kyle Nickodem, Tim Schrader, Wudbhav N. Sankar, Harry K.W. Kim, Jennifer C. Laine, Bella Vakulenko-Lagun, Benjamin Martin, Benjamin Joseph, Charles T. Mehlman, David Y. Chong, Derek M. Kelly, Emmanouil Grigoriou, Eric Fornari, Hitesh Shah, Jeffrey Kessler, Joseph A. Janicki, Juan Carlos Abril, Junichi Tamai, Kishore Mulpuri, Ludwig A. Meiss, Luiz R.A. de Angeli, Mihir M. Thacker, Nicole Williams, Patricia Moreno Grangeiro, Roberto Guarniero, Scott B. Rosenfeld, Scott S. Yang, Shawn R. Gilbert, Merckaert Sophie R, Todd J. Blumberg, Anthony J. Herring, Virginia F. Casey, William Z. Morris, Yasmin D. Hailer
Language: English
Topic: Bone and Joint Diseases
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,050
OpenAlex ID: W7166808258