title: The presentation of Legg-Calvé-Perthes disease in females.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Case series, Level IV.
authors.affiliation: Division of Orthopedic Surgery, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Georgiadis
authors.forename: Mark A
authors.initials: MA
authors.lastname: Seeley
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Yellin
authors.forename: Wudbhav N
authors.initials: WN
authors.lastname: Sankar