Legg-Calvé-Perthes Disease (LCPD) is a rare childhood disorder affecting the hip joint, where an interruption of blood flow to the femoral head causes the bone tissue to die and temporarily collapse. While the disease course is pediatric, the structural damage inflicted upon the hip joint often creates lifelong consequences that manifest severely in adulthood. These long-term effects significantly impact an individual’s quality of life and ability to work. Disability status is determined by evaluating the permanent orthopedic changes and the functional limitations they impose on daily life and employment.
The Orthopedic Legacy of Perthes Disease
The adult consequences of LCPD stem from avascular necrosis (AVN) in the femoral head during childhood. This temporary loss of blood supply kills bone cells, which the body slowly replaces with new tissue. During this healing phase, mechanical stress causes the weakened femoral head to flatten or become misshapen, a deformity often termed coxa plana.
This abnormal shape leads to joint incongruity, meaning the femoral head and hip socket (acetabulum) no longer fit smoothly. The lack of a tight, spherical fit causes uneven pressure distribution across the joint surfaces during movement. This mechanical mismatch accelerates wear on the cartilage, leading to early secondary osteoarthritis. The degree of deformity is a primary predictor of arthritis severity and the need for future intervention.
Measuring Functional Limitations in Adulthood
The structural damage from LCPD results in chronic symptoms and significant limitations. Adults frequently experience deep-seated chronic hip pain that worsens with extended activity or weight-bearing. This discomfort often radiates to the groin or knee, making simple movements difficult.
The structural changes also cause reduced range of motion and stiffness, hindering activities of daily living such as bending, squatting, or tying shoes. Many individuals develop a painful limp or gait alteration because the hip joint cannot comfortably bear weight. Prolonged standing or walking for any significant distance becomes a major challenge, profoundly affecting occupational choices and leisure activities. Studies show that adults who had LCPD have significantly worse pain, physical function, and overall health compared to their peers without the condition.
Evaluation for Formal Disability Status
Formal disability status is determined not by the diagnosis of Perthes disease itself, but by the severity of the residual functional limitations it imposes. In the United States, the Social Security Administration (SSA) assesses claims by evaluating the claimant’s ability to engage in substantial gainful activity. The SSA first checks if the condition meets the specific criteria found in the Listing of Impairments, commonly referred to as the “Blue Book.”
The long-term effects of LCPD generally fall under Section 1.00, Musculoskeletal Disorders. Specifically, criteria for Major Joint Dysfunction (Listing 1.02) or the need for Reconstructive Procedures of a Major Weight-Bearing Joint (Listing 1.03) are frequently used. To meet a listing, the impairment must be extremely severe and supported by extensive medical documentation.
Since meeting a specific listing is difficult, most successful claims rely on demonstrating that the individual’s overall limitations prevent them from performing any work available in the national economy. This involves assessing the individual’s Residual Functional Capacity (RFC), which documents how pain, stiffness, and restricted mobility affect the ability to stand, walk, sit, lift, and carry for a full workday. The SSA considers all medical evidence to determine if the combination of symptoms makes the individual unemployable.
Managing Chronic Symptoms and Adult Treatment Options
Management of chronic pain and functional decline focuses on alleviating symptoms and preserving the joint. Non-surgical strategies are the first line of defense, including physical therapy aimed at strengthening muscles and maintaining flexibility. Weight management is also recommended to reduce mechanical load on the joint.
Pain is typically controlled with analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). For younger adults with significant deformity but less severe arthritis, hip preservation surgery, such as an osteotomy (realigning the bone), may be performed to improve joint fit. However, once degenerative changes are extensive, the definitive treatment to relieve pain and restore function is a total hip arthroplasty (total hip replacement). These replacements are often performed at a much younger age for LCPD patients, sometimes in their 30s or 40s, compared to the general population.