Local Delivery of Single Dose Intra Epiphyseal Bisphosphonates to Prevent the Progression of Legg-Calve-Perthes Disease – Case Series

INTRODUCTION: Legg-Calve´-Perthes disease (LCPD) or avascular necrosis of the capital epiphysis is an idiopathic disease characterized by interruption of the blood supply to the capital femoral epiphysis resulting in necrosis of the epiphysis. There are a variety of treatment modalities such as containment with braces early in disease to surgical procedures for children presenting late in their age group. The newer modalities of treatment are intravenous bisphosphonates, bone morphogenic protein in clinical subjects. CASE REPORT: Two children (Aged 7 years with catterall Stage II unilateral affection, aged 11 years catterall Stage III bilateral affection) were advised single-dose of zoledronic acid(2 mg) into epiphysis as day care procedure after due discussion with parents about other treatment modalities. Both the children were followed up quarterly with clinical examination and radiology. At the latest follow-up of 4 years both had satisfactory outcome. Child one was able to do normal play with intact lateral pillar. Child two had minimal collapse of left hip however clinically pain free. CONCLUSION: Local delivery of single dose of intra epiphyseal zoledronic acid is a relatively harmless procedure and effective in preventing the progression of disease pathology, especially in children with age group of 6–10 years.