A probable case of Legg-Calvé-Perthes disease in Warring States-era China

Abstract

Reports of Legg-Calvé-Perthes disease (LCPD) in the paleopathological literature are rare. Here, the authors present a probable case of LCPD, which presents as abnormal morphology of the proximal femur. The condition was observed in an individual of the Warring States period in Shaanxi Province, China, and the morphology involves a "mushroom head" deformity of the proximal right femur and an enlarged acetabulum, along with a contralateral tibia, talus, and navicular that are enlarged and demonstrate periosteal new bone formation. The authors consider tuberculosis, septic arthritis, trauma, slipped capital femoral epiphysis, and Legg-Calvé-Perthes disease in a differential diagnosis. The authors conclude that the most likely diagnosis for the deformity is Legg-Calvé-Perthes disease. Bony changes in the hip joint and contralateral lower leg suggest that the individual had an altered gait because of the condition.

Case study of Legg-Calvé-Perthes disease observed in Radom (Poland, 18th–19th century) with literature review

“…Generally, the paleopathological evidence of LCPD are scarce. The disease has been previously described in: Peru (Ortner and Putchar 1981;Ortner 2003), Majorca (Marques and Cunha 2001), Serbia (Đurić et al 2004), Czech Republic (Smrcka et al 2009), Portugal (Ferreira et al 2013, Argentina (Ponce and Novellino 2014), Egypt (Fritsch et al 2015), China (Berger et al 2017) and Spain (Manzon et al 2017). Our study provides the first case of LCPD described in bioarchaeological materials from Poland.…”

“…Similar to our sample pathologies has also been identified in ancient Egyptian mummies from the Museum of Antiquities in Cairo by Fritsch et al (2015), who examined orthopaedic diseases in Ancient Egypt, and by Manzon et al (2017) who reported on morphometric and radiological analyses of a skeleton from the Etruscan necropolis of Spina (Ferrara, Italy, 6 th -3 rd century BCE). Similarly, Berger et al (2017) examined skeletal remains of an individual from the Warring States period in Shaanxi Province (China), and observed a "mushroom head" deformity of the proximal right femur, an enlarged acetabulum, along with a contralateral tibia, talus as well as enlarged navicular with periosteal new bone formation. These conditions were also connected with LCPD.…”

“…The disorder is usually observed in boys at the age from 4 to 10 years (Loder and Skopelja 2011;Perry and Hall 2011;Pavone et al 2019). Despite the aetiology of the disease having been widely discussed, it is still not fully understood (Hosalkar and Mulpuri 2012;Berger et al 2017). The best supported theory involves an influence of repetitive mechanical stress on blood supply to the epiphysis (Guerado and Caso 2016;Leo et al 2018).…”

Adult paleopathology as an indicator of childhood social roles: A case study of Perthes disease in a native Ohio female

“…Finally, B8.1's skeleton is consistent with a female, and pubescent girls are less likely than boys to suffer from SCFE because of the action of oestrogen against growth hormone (Jingushi & Suenaga, ). However, because SCFE can also manifest in a flattening of the femoral head similar to the observed mushroom defect (Berger, Chen, Sun, & Sun, ), it cannot be entirely ruled out.…”