Abstract
Background
Total hip arthroplasty (THA) in patients with sequelae of Legg–Calvé–Perthes disease (LCP) is technically demanding because of the disease related deformities occuring in the proximal femur and/or the multiplanar deformities secondary to corrective osteotomies in childhood. Little is known about the long-term outcome of the procedure in this challenging group of patients.
Methods
We carried out a systematic review of the literature to determine the functional outcome, complications and revision rate of THA in patients with sequelae of LCP disease. Six out of 148 potential studies involving 245 hips met the inclusion criteria. The mean age was 45.7 years (19–74) and follow-up was 8.4 years (2–21).
Results
There were 221 cementless THAs (90%), 22 hybrid THAs (9%) and 2 cemented THAs (1%). The femoral components used included 187 standard stems (76%), 43 modular stems (18%) and 15 custom-made stems (6%). The modular implants used were reamed S-Rom stems. All studies reported a significant improvement in hip function following THA. There were 16 revision THAs (7%) occurring at a mean of 7.5 years (0.4–10.3). Complications included intra-operative fracture (11%, n = 27), aseptic loosening (5%, n = 13), sciatic nerve palsy (3%, n = 7) and heterotopic ossification (2%, n = 4). All intra-operative fractures occurred when standard femoral stems were used. The average limb lengthening in the patients with a post-operative sciatic nerve injury was 1.9 cm. All patients with this complication had a history of previous hip surgery.
Conclusions
THA in patients with LCP disease results in similar functional outcome compared to patients with primary osteoarthritis; however, the revision rate at mid-term follow-up is slightly increased. Reamed modular (S-Rom) and custom femoral implants appear to be associated with a decreased risk of intra-operative fracture. Care should be taken when addressing leg length discrepancy in this group of patients due to the increased risk of sciatic nerve palsy, especially in patients with prior surgical procedures.
Similar content being viewed by others
Abbreviations
- THA:
-
Total hip arthroplasty
- LCP:
-
Legg–Calvé–Perthes
References
Gower WE, Johnston RC (1971) Legg–Perthes disease. Long-term follow-up of thirty-six patients. J Bone Jt Surg Am 1971(5):759–768
Kelly FB Jr, Canale ST, Jones RR (1980) Legg–Calve´–Perthes disease. Long-term evaluation of non-containment treatment. J Bone Jt Surg Am 1980(62):400–407
Stulberg SD, Cooperman DR, Wallensten R (1981) The natural history of Legg–Calve´–Perthes disease. J Bone Jt Surg Am 1981(63):1095–1108
Catterall A (1971) The natural history of Perthes’ disease. J Bone Jt Surg Br 1971(53):37–53
Karimi M, McGarry T (2012) A comparison of the effectiveness of surgical and non surgical treatment of Legg–Calve–Perthes disease: a review of the literature. Adv Orthop 2012:490806
Gent E, Clarke NM (2004) Joint replacement for sequelae of childhood hip disorders. J Pediatr Orthop 2004(24):235
Sankar WN, Flynn JM (2008) The development of acetabular retroversion in children with Legg–Calve–Perthes disease. J Pediatr Orthop 2008(28):440
Larson AN, Sucato DJ, Herring JA et al (2012) A prospective multicenter study of Legg–Calve´–Perthes disease: functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years. J Bone Jt Surg Am 2012(94):584–592
Froberg L, Christensen F, Pedersen N, Overgaard S (2012) Radiographic changes in the hip joint in children suffering from Perthes disease. J Pediatr Orthop 2012(21):220–225
Kitakoji T (2005) Which is a better method for Perthes disease: femoral varus or Salter osteotomy? Clin Orthop 2005(430):163–170
Traina F, De Fine M, Sudanese A, Calderoni PP, Tassinari E, Toni A (2011) Long-term results of total hip replacement in patients with Legg–Calvé–Perthes disease. J Bone Jt Surg Am 93(7):e25. doi:10.2106/JBJS.J.00648
Al-Khateeb H, Kwok IH, Hanna SA, Sewell MD, Hashemi-Nejad A (2014) Custom cementless THA in patients with Legg–Calve–Perthes disease. J Arthroplasty 29(4):792e6
Baghdadi YM, Larson AN, Stans AA, Mabry TM (2013) Total hip arthroplasty for the sequelae of Legg–Calve–Perthes disease. Clin Orthop Relat Res 471(9):2980e6
Lim YW, Kim MJ, Lee YS, Kim YS (2014) Total hip arthroplasty in patient with the sequelae of Legg–Calvé–Perthes disease. Hip Pelvis 26(4):214–219. doi:10.5371/hp.2014.26.4.214
Seufert CR, McGrory BJ (2015) Treatment of arthritis associated with Legg–Calve–Perthes disease with modular total hip arthroplasty. J Arthroplasty 30(10):1743–1746. doi:10.1016/j.arth.2015.04.025
Lee SJ, Yoo JJ, Kim HJ (2016) Alumina-alumina total hip arthroplasty for the sequelae of Legg–Calve–Perthes disease: A comparative study with adult-onset osteonecrosis. J Orthop Sci. doi:10.1016/j.jos.2016.07.010
Thillemann TM, Pedersen AB, Johnsen SP, Søballe K (2008) Implant survival after primary total hip arthroplasty due to childhood hip disorders: results from the Danish Hip Arthroplasty Registry. Acta Orthop 79(6):769–776. doi:10.1080/17453670810016830
Lehmann TG, Engesaeter IØ, Laborie LB, Lie SA, Rosendahl K, Engesaeter LB (2012) Total hip arthroplasty in young adults, with focus on Perthes’ disease and slipped capital femoral epiphysis: follow-up of 540 subjects reported to the Norwegian Arthroplasty Register during 1987–2007. Acta Orthop 83(2):159–164. doi:10.3109/17453674.2011.641105 (Epub 2011 Nov 23)
Hannouche D, Devriese F, Delambre J, Zadegan F, Tourabaly I, Sedel L, Chevret S, Nizard R (2016) Ceramic-on-ceramic THA implants in patients younger than 20 years. Clin Orthop Relat Res 474(2):520–527. doi:10.1007/s11999-015-4546-9 (Epub 2015 Sep 4)
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Jt Surg [Am] 51:737–755
Australian Orthopaedic Association National Joint Replacement Registry (2011) Annual Report. AOA, Adelaide
Tamegai H, Otani T, Fujii H, Kawaguchi Y, Hayama T, Marumo K (2013) A modified S-ROM stem in primary total hip arthroplasty for developmental dysplasia of the hip. J Arthroplasty 2013(28):1741–1745
Chiavetta JB, Parvizi J, Shaughnessy WJ, Cabanela ME (2004) Total hip arthroplasty in patients with dwarfism. J Bone Jt Surg Am 2004(86):298–304
Helenius I, Remes V, Tallroth K, Peltonen J, Poussa M, Paavilainen T (2003) Total hip arthroplasty in diastrophic dysplasia. J Bone Jt Surg Am 2003(85):441–447
Peltonen JI, Hoikka V, Poussa M, Paavilainen T, Kaitila I (1992) Cementless hip arthroplasty in diastrophic dysplasia. J Arthroplasty. 7(suppl):369–376
Krishnan H, Krishnan SP, Blunn G, Skinner JA, Hart AJ (2013) Modular neck femoral stems. Bone Jt J 95-B(8):1011–1021. doi:10.1302/0301-620X.95B8.31525 (review)
Pakos EE, Stafilas KS, Tsovilis AE, Vafiadis JN, Kalos NK, Xenakis TA (2015) Long term outcomes of total hip arthroplasty with custom made femoral implants in patients with congenital disease of hip. J Arthroplasty 30(12):2242–2247. doi:10.1016/j.arth.2015.06.038 (Epub 2015 Jun 23)
Farrell CM, Springer BD, Haidukewych GJ, Morrey BF (2005) Motor nerve palsy following primary total hip arthroplasty. J Bone Jt Surg Am 2005(87):2619–2625
Atrey A, Leslie I, Carvell J, Gupte C, Shepperd JA, Powell J et al (2008) Standardised consent forms on the website of the British Orthopaedic Association. J Bone Jt Surg Br 90:422–423
Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ (2009) Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia. J Bone Jt Surg Am 2009(91):2213–2221
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest.
Funding
No funding source.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Hanna, S.A., Sarraf, K.M., Ramachandran, M. et al. Systematic review of the outcome of total hip arthroplasty in patients with sequelae of Legg–Calvé–Perthes disease. Arch Orthop Trauma Surg 137, 1149–1154 (2017). https://doi.org/10.1007/s00402-017-2741-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-017-2741-8