Severe Radiographic Legg-Calvé-Perthes Disease With Favorable Long-Term Functional Outcomes Following Conservative Management: A Case Report.

Legg-Calvé-Perthes disease (LCPD) is a pediatric disorder characterized by avascular necrosis of the femoral head, with prognosis largely determined by the extent of epiphyseal involvement. Severe radiographic classifications are typically associated with poor long-term outcomes and often prompt surgical intervention. We present a case of a male patient diagnosed with unilateral LCPD at age three with extensive femoral head involvement by age six (Catterall Group 4, Salter-Thompson Group B, Herring Group C) who was managed non-operatively over two decades. Treatment consisted of physiotherapy, activity modification, and pain management without surgical intervention. Despite marked femoral head deformity and residual limitations in hip range of motion, the patient achieved high functional capacity, including participation in National Collegiate Athletic Association (NCAA) Division I athletics, and he maintains independence in activities of daily living as a young adult. This case highlights the potential for favorable functional outcomes with conservative management in carefully selected patients with poor-prognosis LCPD and underscores the importance of individualized treatment planning.