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Published on: September 7, 2022
Long-term results of total hip replacement in patients with Legg-Calvé-Perthes disease
Francesco Traina1, Marcello De Fine, Alessandra Sudanese
11st Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy. traina@tecno.ior.it
Insights
Total hip replacement is a viable option for adults with a history of Legg-Calvé-Perthes disease, offering significant functional improvement despite potential neurological complications. Careful surgical planning is essential for optimal outcomes in these complex cases.
Area of Science:
- Orthopedic Surgery
- Reconstructive Surgery
Background:
- Legg-Calvé-Perthes disease can lead to complex hip deformities, complicating adult reconstructive surgery.
- Previous childhood interventions for Legg-Calvé-Perthes disease may further increase surgical difficulty.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of total hip replacement in patients with a history of Legg-Calvé-Perthes disease.
- To assess functional outcomes and complication rates following hip arthroplasty in this specific patient cohort.
Main Methods:
- Retrospective analysis of 32 total hip replacements in 27 patients (1989-2004).
- Average patient age at surgery was 37.8 years, with an average follow-up of 124 months.
- Predominantly cementless implants were utilized, with only one cemented stem included.
Main Results:
- A high cumulative survival rate of 96.9% at 15 years was observed.
- Significant functional improvement was noted, with average Harris hip scores increasing from 50.1 preoperatively to 87.5 postoperatively.
- The overall complication rate was 12.5%, including two cases of permanent sciatic nerve palsy.
Conclusions:
- Total hip replacement is a feasible treatment for Legg-Calvé-Perthes disease patients, despite challenges.
- Careful preoperative planning is crucial to address anatomical abnormalities and minimize surgical risks.
- Neurological complications warrant attention, possibly linked to limb lengthening or soft tissue management.
Background:
Total hip replacement in patients with Legg-Calvé-Perthes disease can be difficult because of the multiplanar deformities of the proximal part of the femur and previous surgery during childhood. The aim of the present study was to assess the long-term outcomes of total hip replacement in patients who had Legg-Calvé-Perthes disease during childhood.
Methods:
A retrospective study was carried out to assess the results of thirty-two total hip replacements that had been performed for twenty-seven patients from January 1989 to November 2004. The average age at the time of surgery was 37.8 years. The average duration of follow-up was 124 months (range, fifty-eight to 248 months). All but one of the implants were cementless.
Results:
There was only one failure in the present study; specifically, the one cemented stem in the study failed two years after surgery. The cumulative survival rate at fifteen years was 96.9% (95% confidence interval, 90.8% to 100.0%). The overall rate of complications was 12.5%, with two permanent sciatic nerve palsies. At the time of the latest follow-up, the average Harris hip score was 87.5 (range, 73 to 96), which was a marked improvement in comparison with the preoperative score (average, 50.1; range, 25 to 75).
Conclusions:
Despite the high rate of neurological complications, possibly related to excessive limb lengthening or inadequate soft-tissue release, total hip replacement can be considered a feasible option for patients with Legg-Calvé-Perthes disease. Careful preoperative planning is advisable in order to overcome the technical pitfalls related to the abnormal proximal femoral and acetabular anatomy of these patients.
