Limits...
The presentation of Legg-Calvé-Perthes disease in females.

Georgiadis AG, Seeley MA, Yellin JL, Sankar WN - J Child Orthop (2015)

Bottom Line: Demographic, clinical, and radiographic data for all female patients were examined and compared to historical norms.There were four female patients who presented for initial diagnosis >ten years of age.Case series, Level IV.

View Article: PubMed Central - PubMed

Affiliation: Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.

ABSTRACT

Purpose: Legg-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.

Methods: All 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.

Results: Four-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.

Conclusions: There 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 evidence: Case series, Level IV.

No MeSH data available.


Related in: MedlinePlus

AP and frog lateral radiographs prototypical of the presentation of female Perthes disease, with femoral head fragmentation and loss of height of the lateral pillar
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4549350&req=5

Fig1: AP and frog lateral radiographs prototypical of the presentation of female Perthes disease, with femoral head fragmentation and loss of height of the lateral pillar

Mentions: Institutional Review Board approval was obtained for this investigation at a single tertiary referral children’s hospital. International statistical classification of diseases revision 9 (ICD-9) codes 732.1 (‘juvenile osteochondrosis of the hip and pelvis’) and 733.42 (‘avascular necrosis of hip’) were queried for the years 1990–2014. The ICD-9 codes for AVN were utilized to ensure the collection of patients who may have been miscoded and exclusively identify those with truly idiopathic AVN. All inpatient, outpatient, and radiographic records were reviewed. All patients presenting with a diagnosis of LCPD were identified. Inclusion criteria were a diagnosis of Perthes disease, female gender, age <18 years, and a minimum of two serial anteroposterior (AP) and frog lateral pelvis radiographs to establish radiographic disease progression. We excluded patients who presented with a healed late-onset deformity (whose acute/initial presentation data was therefore unavailable), anyone with a history of hip pathology prior to presentation, and any patient with secondary AVN (e.g., sickle-cell disease, steroid use, chemotherapy). Data collected included demographics (race, body mass index [BMI], age of menarche, past medical history), presentation data (sidedness, age at presentation, chief complaint, presenting symptoms, presence/absence of limp, duration of symptoms, sports and activity history) and radiographic data (Fig. 1).Fig. 1


The presentation of Legg-Calvé-Perthes disease in females.

Georgiadis AG, Seeley MA, Yellin JL, Sankar WN - J Child Orthop (2015)

AP and frog lateral radiographs prototypical of the presentation of female Perthes disease, with femoral head fragmentation and loss of height of the lateral pillar
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4549350&req=5

Fig1: AP and frog lateral radiographs prototypical of the presentation of female Perthes disease, with femoral head fragmentation and loss of height of the lateral pillar
Mentions: Institutional Review Board approval was obtained for this investigation at a single tertiary referral children’s hospital. International statistical classification of diseases revision 9 (ICD-9) codes 732.1 (‘juvenile osteochondrosis of the hip and pelvis’) and 733.42 (‘avascular necrosis of hip’) were queried for the years 1990–2014. The ICD-9 codes for AVN were utilized to ensure the collection of patients who may have been miscoded and exclusively identify those with truly idiopathic AVN. All inpatient, outpatient, and radiographic records were reviewed. All patients presenting with a diagnosis of LCPD were identified. Inclusion criteria were a diagnosis of Perthes disease, female gender, age <18 years, and a minimum of two serial anteroposterior (AP) and frog lateral pelvis radiographs to establish radiographic disease progression. We excluded patients who presented with a healed late-onset deformity (whose acute/initial presentation data was therefore unavailable), anyone with a history of hip pathology prior to presentation, and any patient with secondary AVN (e.g., sickle-cell disease, steroid use, chemotherapy). Data collected included demographics (race, body mass index [BMI], age of menarche, past medical history), presentation data (sidedness, age at presentation, chief complaint, presenting symptoms, presence/absence of limp, duration of symptoms, sports and activity history) and radiographic data (Fig. 1).Fig. 1

Bottom Line: Demographic, clinical, and radiographic data for all female patients were examined and compared to historical norms.There were four female patients who presented for initial diagnosis >ten years of age.Case series, Level IV.

View Article: PubMed Central - PubMed

Affiliation: Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.

ABSTRACT

Purpose: Legg-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.

Methods: All 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.

Results: Four-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.

Conclusions: There 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 evidence: Case series, Level IV.

No MeSH data available.


Related in: MedlinePlus