The presentation of Legg−Calvé−Perthes disease in females

Abstract

PurposeLegg−Calvé−Perthes disease (LCPD) is uncommon in girls. The presentation of LCPD in female patients has been reported as later in onset and associated with certain high-impact activities. Our aim is to characterize the presentation of female LCPD at a large center, with particular attention to the clinical and radiographic features of late-onset disease (>ten years of age). We perceived an increasing burden of late-onset disease with adult-like radiographic features.MethodsAll patients presenting to a single large urban children’s hospital from 1990−2014 with a diagnosis of LCPD were reviewed. Demographic, clinical, and radiographic data for all female patients were examined and compared to historical norms.ResultsFour-hundred and fifty-one patients presented with LCPD in the study period, of which 82 (18.2 %) were female. The average age at presentation was 6.58 years in girls, which is similar to the classically reported mean age. Fourteen patients participated in high-impact repetitive activities or those with deep flexion and abduction, although few were late presenters. There were four female patients who presented for initial diagnosis >ten years of age.ConclusionsThere was a paucity of late-onset LCPD in girls in the study population, and the females with LCPD had a very similar age and character to their presentation as did males. Although their presentation is infrequent, three of four older females with LCPD were engaged in high-level physical activity, and their disease may be attributed to high-impact, repetitive athletics.Level of evidenceCase series, Level IV.

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

“…The condition described above was diagnosed as likely being LCPD of the hip. LCPD occurs in several stages, and onset is typically between the ages of four and eight years (Georgiadis, Seeley, Yellin, & Sankar, ), although some cases do occur in early childhood and adolescence (Gill, ).…”

“…LCPD occurs more frequently in boys than girls (Gill, , Gray, Lowry, & Renwick, , Hall, Barker, Dangerfield, & Taylor, , Kim, Hiroshima, & Imaeda, , Moberg & Rehnberg, ). When present in girls, it is associated with high impact sports or repetitive athletics (e.g., Georgiadis et al, ; Larson, Kim, & Herring, ), and animal experiments have successfully induced LCPD through repetitive activity (Zhang et al, ). However, Kim et al () found that only 14.2% of affected children were athletes.…”

“…One potential explanation for the presence of LCPD in B8.1 could be that the body of a young girl might have been vulnerable to repeated microtrauma of prolonged strenuous activity involving the muscles of hip flexion and extension (e.g., digging, hoeing, carrying hay, bending, twisting, and lifting), which could have restricted blood flow to the femoral head and ultimately result in LCPD. Indeed, modern children of short stature have been shown to be more frequently affected by LCPD than tall children (Eckerwall, Wingstrand, Hägglund, & Karlberg, ; Lee, Vaidya, Song, Lee, & Telang, ), as are children who participate in high intensity sports and repetitive activities (e.g., Georgiadis et al, ; Larson et al, ). Additionally, the risk of suffering from an activity‐related injury is heightened during periods of rapid growth when bone growth is faster than muscle growth.…”

Aetiology of Legg-Calvé-Perthes disease: A systematic review

“…In particular, pioneer studies on these differences reported a more severe presentation and prognosis in female patients than in male subjects[ 97 ]. However, recent high profile epidemiological studies reported no significant differences in clinical presentation, outcome and prognosis between boys and girls[ 98 , 99 ]. Thus, the LCPD male/female ratio appears not to be associated with different clinical presentation and should not be part of the clinical treatment algorithm.…”

Familial cases of Mexican patients with Legg-Calvé-Perthes disease

“…LCPD has a very variable incidence, it ranges between 0.4/100000 and 29.0/100000, and its appearance is mainly in males. Unfortunately, in our country, there is no prevalence data, but, due to its occurrence and appearance, it is considered as a low incidence disease [5][6][7]. There are multiple theories about the etiology of LCPD; however, many of them remain controversial due to lack of foundation and/or reproducibility.…”