Hip Pelvis.  2014 Dec;26(4):214-219. 10.5371/hp.2014.26.4.214.

Total Hip Arthroplasty in Patient with the Sequelae of Legg-Calve-Perthes Disease

• Lim YW
• Kim MJ
• Lee YS
• Kim YS

• KMID: 1907696
• DOI: http://doi.org/10.5371/hp.2014.26.4.214

Abstract

PURPOSE
Patients who have secondary hip osteoarthritis as sequelae of Legg-Calve-Perthes disease (LCPD) are severe deformities of femoral head and acetabulum. A few studies have presented that the clinical results and risks associated with total hip arthroplasty (THA) for patients with a history of LCPD were not satisfactory. In this study, we reported the radiographic and clinical outcomes of THA in patients with sequelae of LCPD.
MATERIALS AND METHODS
Between March 2007 and May 2012, 23 hips (23 patients) underwent cementless THA and were followed up at least 2 years after surgery. There were 11 male patients and 12 female patients with an average age of 49.2 years old (range, 25 to 69 years old), and the average follow up period was 40.8 months (range, 24 to 84 months). The clinical and radiological evaluations were performed.
RESULTS
The Harris hip score improved from 48.3 points preoperatively to 92.4 points at the time of the last follow-up. The shortening of affected limb was improved from -1.6 cm to 0.2 cm. The complications included one case of sciatic nerve palsy that developed after extensive lengthening of lower extremity, three cases of intraoperative femur fractures. There was no component loosening.
CONCLUSION
Fractures and motor nerve palsies may be more frequent in this population. Careful preoperative planning should be performed to overcome the technical pitfalls. If overcoming this early complication, the clinical and radiological evaluations showed excellent outcomes at average 40-month follow-ups.

Keyword

Legg-Calve-Perthes disease; LCP Sequelae; Total hip arthroplasty

MeSH Terms

Acetabulum
Arthroplasty, Replacement, Hip*
Congenital Abnormalities
Extremities
Female
Femur
Follow-Up Studies
Head
Hip
Humans
Legg-Calve-Perthes Disease*
Lower Extremity
Male
Osteoarthritis, Hip
Paralysis
Sciatic Neuropathy

Figure

• 

  Fig. 1 (A) This anteroposterior radiography shows secondary osteoarthritis caused by sequelae of Legg-Calvé-Perthes disease in a 57-year-old male. (B) The immediate postoperative radiography shows good positioning of the prosthesis. (C) After 5 years, the radiograph shows no osteolysis around the right acetabular and femoral component, and stable components with proper bony ingrowth.

• 

  Fig. 2 (A) This anteroposterior radiography shows secondary osteoarthritis caused by sequelae of Legg-Calvé-Perthes disease in a 35-year-old female. Preoperatively, leg length discrepancy was measured about 1.3 cm. (B) The immediate postoperative radiography shows that the affected limb was over-lengthened about 7 mm. The patients complained severe neurogenic pain on the affected leg, and motor weakness (Grade 0). (C) The total hip arthroplasty was revised with medicalization of acetabular cup and exchanging with smaller sized stem. Postoperatively, leg length discrepancy was not examined. (D) After 2 years, the radiograph shows no osteolysis around the right acetabular and femoral component, and the sciatic nerve palsy was improved (Grade IV).

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