Total Hip Arthroplasty in Legg-Calve-Perthes Disease: Mean Nine-Year Outcomes of 201 Hips
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Published on: September 7, 2022
Diego J Restrepo1, Aaron G Chen2, Sergio F Guarin Perez1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Total hip arthroplasty (THA) for Legg-Calvé-Perthes (LCPD) disease demonstrates excellent 15-year survivorship, with low revision rates. However, surgeons must remain vigilant for potential complications like sciatic neuropraxia and fractures.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Reconstructive Surgery
Background:
- Legg-Calvé-Perthes (LCPD) disease presents a unique challenge for total hip arthroplasty (THA).
- This study reports outcomes from one of the largest single-center contemporary series of THA in LCPD patients.
Purpose of the Study:
- To evaluate the long-term survivorship and complication rates of contemporary total hip arthroplasty (THA) in patients with Legg-Calvé-Perthes (LCPD) disease.
- To assess the functional outcomes and specific complications associated with THA for LCPD.
Main Methods:
- A review of 201 total hip arthroplasties (THAs) for Legg-Calvé-Perthes (LCPD) disease performed between 2000 and 2020.
- Analysis included bearing surfaces (C-HXLPE, Metal-HXLPE, CoC, MoM), fixation methods (cementless/cemented), and patient demographics (mean age 47, BMI 32, 74% male).
- Follow-up averaged nine years (range 2-22), assessing survivorship, complications, leg-length discrepancy, and Harris hip scores (HHS).
Main Results:
- Fifteen-year survivorship free of aseptic revision, any revision, and any reoperation was 99%, 98%, and 95%, respectively.
- Complications occurred in 30 hips, most commonly sciatic neuropraxia (n=10) and intraoperative fracture (n=9).
- Mean leg-length discrepancy improved from -18mm preoperatively to +15mm postoperatively; mean HHS improved from 55 to 92 (P<0.0001).
Conclusions:
- Contemporary total hip arthroplasty (THA) in Legg-Calvé-Perthes (LCPD) disease yields excellent 15-year survivorship.
- Surgeons must be aware of the notable incidence of complications, particularly sciatic neuropraxia and intraoperative fractures.
- Significant functional improvement, as measured by HHS, is achievable in these challenging cases.
Background:
Legg-Calvé-Perthes disease (LCPD) is an uncommon, but challenging indication for total hip arthroplasty (THA). We aimed to report one of the largest single-center contemporary series of THA associated with this condition.
Methods:
We reviewed 201 THAs for LCPD performed at a single institution between 2000 and 2020. The mean age at surgery was 47 years, the mean body mass index was 32 and 74% were men. Bearing surfaces included ceramic-on-highly cross-linked polyethylene in 95 hips (47%), metal-on-highly cross-linked polyethylene in 83 hips (41%), ceramic-on-ceramic in 17 hips (9%), and metal-on-metal in six hips (3%). All acetabular components were cementless. Cementless and cemented femoral stems were used in 188 (93%) and 14 hips (7%), respectively. The mean follow-up was nine years (range, two to 22).
Results:
At 15 years, survivorships free of aseptic revision, any revision, and any reoperation were 99, 98, and 95%, respectively. Indications for revision were infection (n = 2), postoperative fracture (n = 1), and metallosis (n = 1). There were no significant differences in survivorship between hips with prior surgical treatment of LCPD (n = 8) and those without (n = 153). Complications occurred in 30 hips, most commonly sciatic neuropraxia (n = 10) and intraoperative fracture (n = 9). Preoperatively, patients had a mean leg-length discrepancy of 18 mm shorter on the operative limb. Postoperatively, the operative limb was lengthened by a mean of 15 mm. There was no difference in mean lengthening between patients who had sciatic neuropraxia and those who did not (12 versus 15 mm; P = 0.365). There were seven neuropraxias resolved, while three patients had persistent deficits at the latest follow-up. The mean Harris Hip Score improved preoperatively from 55 to 92 at 10-year follow-up (P < 0.0001).
Conclusion:
At 15 years, patients who had LCPD undergoing contemporary THA showed excellent survivorship free of revision and reoperation. Surgeons should be aware that complications were not uncommon, especially sciatic neuropraxia and intraoperative fractures.
Level Of Evidence:
III.
