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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Total hip arthroplasty for the sequelae of Legg-Calvé-Perthes disease
Yaser M K Baghdadi1, A Noelle Larson, Anthony A Stans
1Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
Insights
Total hip arthroplasty (THA) for Legg-Calvé-Perthes disease (LCPD) shows 90% survival at 8 years. This surgery can be complex, with risks including fractures and nerve injuries, necessitating careful limb lengthening.
Area of Science:
- Orthopedic Surgery
- Reconstructive Surgery
Background:
- Legg-Calvé-Perthes disease (LCPD) can lead to long-term hip joint issues.
- The outcomes and risks of total hip arthroplasty (THA) in LCPD patients are not well-documented.
Purpose of the Study:
- Evaluate the survivorship of THA in patients with a history of LCPD.
- Assess functional hip scores and complication rates following THA in this population.
- Compare THA outcomes between patients with a history of childhood surgery versus conservative management for LCPD.
Main Methods:
- Retrospective review of 99 primary THAs in 95 patients with LCPD.
- Minimum 2-year follow-up (mean 8 years).
- Analysis of implant survival, hip scores, and complications.
Main Results:
- Eight-year survival rate was 90% for cementless THA versus 86% for hybrid THA.
- Mean Harris hip score improved significantly post-surgery.
- Complications occurred in 16% of hips, including intraoperative fractures and sciatic nerve palsy, particularly with greater limb lengthening.
Conclusions:
- Cementless THA offers 90% survival at 8 years for LCPD sequelae.
- THA in LCPD patients is technically challenging, with notable risks of intraoperative fractures and nerve injury.
- Avoiding excessive limb lengthening is crucial to minimize complications.
Background:
The durability and risks associated with total hip arthroplasty (THA) for patients with a history of Legg-Calvé-Perthes disease (LCPD) are not well known.
Questions/Purpose:
We sought to (1) determine the survivorship of THAs performed for LCPD; (2) assess hip scores and complications associated with THA in this patient population; and (3) compare results between patients who had undergone surgery in childhood with patients who had conservative treatment.
Methods:
We reviewed 99 primary THAs performed in 95 patients with a history of LCPD with minimum 2-year followup (mean ± SD, 8 ± 5 years). Mean age at THA was 48 ± 15 years.
Results:
A total of 10 revisions were performed. Using revision for any reason as the end point, the 8-year survival rate was 90% (95% confidence interval [CI], 76%-96%) for cementless implants compared with 86% (95% CI, 57%-96%) for hybrid implants. The mean Harris hip score improved by 31 ± 16 (n = 76). Complications occurred in 16% of hips. The most common major complication was intraoperative fracture (eight femoral, one acetabular). Three patients developed sciatic nerve palsy after a mean lengthening of 2.2 ± 1 cm compared with a mean of 1.4 ± 1 cm in patients with intact sciatic nerve (p = 0.3).
Conclusions:
Cementless THAs for the sequelae of LCPD demonstrate 90% survival from any revision at 8 years followup. THAs for the sequelae of LCPD can be complicated and technically difficult. Intraoperative fractures and nerve injuries are common. Care should be taken to avoid excessive limb lengthening.
