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Carender CN, Bothun CE, Sierra RJ, Trousdale RT, Abdel MP, Bedard NA. Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age: Results of >500 Cases. J Bone Joint Surg Am 2024; 106:1108-1116. [PMID: 38687829 DOI: 10.2106/jbjs.23.01467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND There has been a paucity of long-term outcomes data on aseptic revision total hip arthroplasties (THAs) in the young adult population. The purpose of this study was to evaluate implant survivorship, complications, and clinical outcomes in a large cohort of contemporary aseptic revision THAs in patients ≤50 years of age at the time of the surgical procedure. METHODS We identified 545 aseptic revision THAs performed at a single academic institution from 2000 to 2020 in patients who were 18 to 50 years of age. Patients who underwent conversion THAs and patients with a history of any ipsilateral hip infection were excluded. The mean age was 43 years, the mean body mass index (BMI) was 29 kg/m 2 , and 63% were female. The index indication for revision THA was aseptic loosening in 46% of cases, polyethylene wear or osteolysis in 28% of cases (all revisions of conventional polyethylene), and dislocation in 11% of cases. There were 126 hips (23%) that had undergone at least 1 previous revision (median, 1 revision [range, 1 to 5 revisions]). The mean follow-up was 10 years. RESULTS In the entire cohort, the 20-year survivorship free of any re-revision was 76% (95% confidence interval [95% CI], 69% to 82%). There were 87 re-revisions, with 31 dislocations, 18 cases of aseptic loosening of the femoral component, and 16 periprosthetic joint infections (PJIs) being the most common reasons for re-revision. Dislocation as the indication for the index revision was associated with an increased risk of re-revision (hazard ratio, 2.9; p < 0.001). The 20-year survivorship free of any reoperation was 73% (95% CI, 66% to 78%). There were 75 nonoperative complications (14%), including 32 dislocations. The mean Harris hip score significantly improved (p < 0.001) from 65 preoperatively to 81 at 10 years postoperatively. CONCLUSIONS Contemporary aseptic revision THAs in patients ≤50 years of age demonstrated a re-revision risk of approximately 1 in 4 at 20 years. Dislocation, aseptic loosening of the femoral component, and PJI were the most common reasons for re-revision. Index revision THAs for dislocation had a 3 times higher risk of re-revision. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Tong Y, Ihejirika-Lomedico R, Rathod P, Deshmukh A. Approaching total hip arthroplasty after Legg-Calvé-Perthes disease: A case series and literature review. J Clin Orthop Trauma 2024; 53:102478. [PMID: 39040624 PMCID: PMC11260328 DOI: 10.1016/j.jcot.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/14/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Due to femoral head-neck deformities and hip joint incongruence, patients with Legg-Calvé-Perthes Disease (LCPD) commonly require total hip arthroplasty (THA) in the fifth and sixth decades of life. These patients present additional challenges to arthroplasty surgeons not only because of their complicated hip anatomy but also because patients may have undergone prior operative procedures in childhood and thus present with pre-existing proximal femoral deformities. THA in LCPD patients can be associated with peri-operative complications such as fracture or nerve injury, and the rate of reoperation has been reported to be higher in the LCPD population as compared to the general population undergoing THA. Despite this, multiple case reports and studies have shown the relative long-term success of THA in patients with history of LCPD. In particular, uncemented modular stems are a commonly used implant choice in such cases. This article reviews and discusses the technical considerations for THA in patients with LCPD and highlights three such cases.
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Affiliation(s)
- Yixuan Tong
- NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA
| | | | - Parthiv Rathod
- NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA
| | - Ajit Deshmukh
- NYU Langone Orthopedic Hospital, Department of Orthopedics, New York, NY, USA
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Hasler J, Flury A, Hoch A, Cornaz F, Zingg PO, Rahm S. Total hip arthroplasty through the direct anterior approach for sequelae of Legg-Calvé-Perthes disease. Arch Orthop Trauma Surg 2023; 143:5935-5944. [PMID: 36806985 PMCID: PMC10449662 DOI: 10.1007/s00402-023-04791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Due to multiplanar deformities of the hip, total hip arthroplasty (THA) for sequelae of Legg-Calvé-Perthes disease (LCPD) is often technically demanding. This study aimed to compare the clinical and radiographic outcomes of patients with sequelae of LCPD undergoing THA through the direct anterior approach (DAA) and non-anterior approaches to the hip. METHODS All patients with sequelae of LCPD who underwent primary THA between 2004 and 2018 (minimum follow-up: 2 years) were evaluated and separated into two groups: THA through the DAA (Group AA), or THA through non-anterior approaches to the hip (Group non-AA). Furthermore, a consecutive control group of patients undergoing unilateral THA through the DAA for primary hip osteoarthritis (Group CC) was retrospectively reviewed for comparison. RESULTS Group AA comprises 14 hips, group non-AA 17 hips and group CC 30 hips. Mean follow-up was 8.6 (± 5.2; 2-15), 9.0 (± 4.6; 3-17) and 8.1 (± 2.2; 5-12) years, respectively. At latest follow-up, Harris Hip Score was 90 (± 20; 26-100), 84 (± 15; 57-100), and 95 (± 9; 63-100) points, respectively. Overall, 6 patients treated for LCPD (each 3 patient in the AA and non-AA group) developed postoperative sciatic nerve palsy, of which only one was permanent. Complication-related revision rate at the latest follow-up was 15% in the AA-group and 25% in the non-AA group, respectively. CONCLUSION THA through the DAA might be a credible option for the treatment of sequelae of LCPD with comparable complication rates and functional outcomes to non-anterior approaches.
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Affiliation(s)
- Julian Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Relative Femoral Neck Lengthening in Legg-Calvé-Perthes Total Hip Arthroplasty. Arthroplast Today 2022; 15:61-67. [PMID: 35399986 PMCID: PMC8991231 DOI: 10.1016/j.artd.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/16/2022] [Accepted: 02/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background Total hip replacement (THR) in patients with a history of Legg-Calvé-Perthes disease can be a technically challenging procedure due to the distorted hip morphology. We propose a technique in which THR is preceded by a modified relative femoral neck lengthening (RFNL) procedure. Hereby, we aim to restore the biomechanical parameters. Methods Twenty-eight patients underwent RFNL in preparation of a second-stage THR between December 2011 and September 2019. The mean age was 38.1 ± 11.4 years. Radiographs were analyzed for centrotrochanteric distance, lateral displacement of the greater trochanter, and leg length discrepancy to assess the biomechanical restoration. Complication rate, reoperation rate, and patient-reported outcome measures were measured. Results Mean centrotrochanteric distance increased from −18.7 ± 6.7 mm preoperatively to 1.9 ± 9.0 mm (P < .001) after RFNL and to 11.4 ± 10.4 mm after THR (P < .001). Mean lateral displacement of the greater trochanter increased from 34.2 ± 8.1 mm preoperatively to 42.4 ± 5.2 mm (P < .001) after RFNL and to 49.9 ± 8.3 mm after THR (P < .001). Leg length discrepancy decreased from 17.5 ± 10.5 mm to 2.7 ± 2.2 mm after THR (P < .001). Mean Harris Hip Score improved from 56.9 ± 17.6 preoperatively to 89.4 ± 10.7 at the latest follow-up (P < .001). Eight patients (8 hips) postponed THR because of sufficient clinical improvement, at a mean follow-up of 4.2 ± 2.1 years. Two hips needed a revision RFNL due to non-union (7.1%), and 1 hip replacement was revised due to a deep infection (5.0%). Conclusions RFNL prior to THR in patients with end-stage osteoarthritis following Legg-Calvé-Perthes disease allows for utilizing regular implants with straight access to the femoral canal, with restored biomechanics and restoration of leg length. The prominent overhanging greater trochanter is reduced to prevent postoperative extra-articular impingement.
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Sansanovicz D, Croci AT, Vicente JRN, Ejnisman L, Miyahara HDS, Gurgel HDMC. Artroplastia total do quadril não cimentada em pacientes com osteoartrose secundária à doença de Legg-Calvé-Perthes em comparação com a osteoartrose primária: Um estudo caso-controle. Rev Bras Ortop 2021; 57:843-850. [PMID: 36226203 PMCID: PMC9550378 DOI: 10.1055/s-0041-1732330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/11/2021] [Indexed: 11/06/2022] Open
Abstract
Objective
To perform a comparative clinical, functional and radiographic evaluation of total hip arthroplasty (THA) performed with a cementless prosthesis in cases of osteoarthrosis secondary to Legg-Calvé-Perthes Disease (LCPD) and in cases of primary osteoarthrosis.
Methods
In the present case-control study, we reviewed medical records of patients admitted to a university hospital between 2008 and 2015 to undergo THA due to LCPD sequelae and compared them with a control group of patients who underwent the same surgery due to primary hip osteoarthrosis. We recruited patients for clinical, functional, and radiographic analysis and we compared the evaluations in the immediate postoperative period and at the last follow-up visit, considering surgical time, size of prosthetic components, and complications.
Results
We compared 22 patients in the study group (25 hips) with 22 patients (25 hips) in the control group, all of whom had undergone THA with the same cementless prosthesis. There was greater functional impairment in the group of patients with LCPD sequelae (
p
= 0.002). There were 4 intraoperative femoral periprosthetic fractures in the LCPD group and none in the primary osteoarthrosis group (
p
= 0.050).
Conclusions
There is an increased risk of intraoperative periprosthetic femoral fracture and worse clinical-functional results in patients undergoing cementless THA due to osteoarthrosis secondary to LCPD sequelae than in those who have undergone the same surgery due to primary hip osteoarthrosis.
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Affiliation(s)
- Dennis Sansanovicz
- Disciplina de Ortopedia e Traumatologia, Faculdade de Medicina da Universidade de Santo Amaro, Universidade de Santo Amaro, São Paulo, SP, Brasil
| | - Alberto Tesconi Croci
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - José Ricardo Negreiros Vicente
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Leandro Ejnisman
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Helder de Souza Miyahara
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Henrique de Melo Campos Gurgel
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Anthony CA, Wasko MK, Pashos GE, Barrack RL, Nunley RM, Clohisy JC. Total Hip Arthroplasty in Patients With Osteoarthritis Associated With Legg-Calve-Perthes Disease: Perioperative Complications and Patient-Reported Outcomes. J Arthroplasty 2021; 36:2518-2522. [PMID: 33674165 DOI: 10.1016/j.arth.2021.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Complications and patient-reported outcomes (PROs) of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) have demonstrated variable results. The purpose of this study was to use a validated grading scheme to analyze complications associated with THA in patients with residual LCPD deformities. Second, we report PROs and intermediate-term survivorship in this patient population. METHODS A retrospective, single-center review was performed on 61 hips in 61 patients who underwent THA for residual Perthes disease. Average patient age was 42 years and 26% of hips had previous surgery. Complications were determined and categorized using a validated grading scheme that included five grades based on the treatment required to manage the complication and on persistent disability. PROs were compared from preoperative to most recent follow-up time points. RESULTS Major complications (grade III) occurred in three patients (5%) which each required a second surgical intervention. The most common minor grade I or II complications (11.5%) were asymptomatic heterotopic ossification (3.3%). Patients were lengthened on the surgical side an average of 1.4 cm with no nerve palsies. All patient PROs improved from preoperative to postoperative time points with the modified Harris Hip Score improving from 46.9 preoperatively to 85.4 postoperatively (P < .01). Patients free from revision for any reason at final follow-up (5.6 years; range 2-13 years) was 98.4% with one patient needing a revision of their femoral component. CONCLUSIONS THA for the sequelae of the LCPD has an acceptable complication rate and provides excellent patient reported outcomes at mid-term follow-up.
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Affiliation(s)
- Chris A Anthony
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA; Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Marcin K Wasko
- Department of Radiology and Imaging, The Medical Center for Postgraduate Education in Warsaw, Otwock, Poland
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO
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Takahashi E, Kaneuji A, Florissi I, Bragdon CR, Malchau H, Kawahara N. Satisfactory Outcomes in Patients Operated With Primary Total Hip Arthroplasty for Perthes-like Deformities: Results From a Surgical Technique Utilizing a Conical Stem, an Elevated Hip Center, and No Shortening Femoral Osteotomy. Arthroplast Today 2020; 7:29-36. [PMID: 33521194 PMCID: PMC7818598 DOI: 10.1016/j.artd.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/01/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Total hip arthroplasty (THA) performed on patients with Perthes-like deformities are technically challenging because of the patient's abnormal hip anatomy. Patients with Perthes-like deformities are at a higher risk of revision, aseptic loosening, nerve injury, and intraoperative fracture after THA, especially if shortening osteotomies are performed. This analysis sought to examine the clinical and radiographic outcomes of a patient cohort with Perthes-like deformities receiving THA with a conical stem, an elevated hip center, and no shortening femoral osteotomy. Methods Twenty-six patients (27 hips) received THA with MODULUS femoral stems, ceramic or metal femoral heads, and highly cross-linked polyethylene liners between April 2011 and March 2016. All patients were treated at a single center by 4 participating surgeons. Patients completed 2 questionnaires preoperatively and at the final follow-up visit (between 1 and 5 years postoperatively): Harris Hip Score and Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire. Differences in patient-reported outcome measures (PROM) scores were measured by paired t-tests. Preoperative and postoperative anteroposterior radiographs were analyzed to monitor patient outcomes. Results Significant clinical improvements were observed in all individual subcategories of the Harris Hip Score and of the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire; the largest magnitude improvements were observed in the subcategory of pain relief for both questionnaires. No complications, including intraoperative and postoperative femoral fractures, nerve palsy, dislocations, or deep venous thrombosis, were observed. Conclusion This study found that patients treated with an elevated hip center and low stem-positioning technique using a conical, modular implant system had good clinical outcomes and did not suffer complications at the mean follow-up from surgery of 2.8 years (range: 1-5 years).
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Affiliation(s)
- Eiji Takahashi
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Corresponding author. Daigaku 1-1, Uchinada-Machi, Kahoku-Gun, Ishikawa 920-0293, Japan. Tel.: +81 76 218 8000.
| | - Ayumi Kaneuji
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
| | - Isabella Florissi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
| | - Charles R. Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedics, Sahlgrenska University Hospital, Mo¨lndal, Sweden
| | - Norio Kawahara
- Department of Orthopedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawak, Japan
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CORR Insights®: What are the Demographics and Epidemiology of Legg-Calvé-Perthes Disease in a Large Southern California Integrated Health System? Clin Orthop Relat Res 2018; 476:2351-2352. [PMID: 30422968 PMCID: PMC6259885 DOI: 10.1097/corr.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Imageless Navigation Improves Intraoperative Monitoring of Leg Length Changes during Total Hip Arthroplasty for Legg-Calve-Perthes Disease: Two Case Reports. Case Rep Orthop 2018; 2018:4362367. [PMID: 30123597 PMCID: PMC6079508 DOI: 10.1155/2018/4362367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/14/2018] [Indexed: 11/22/2022] Open
Abstract
Legg-Calve-Perthes disease is a rare condition characterized by avascular necrosis and malformation of the femoral head. For many patients, total hip arthroplasty (THA) is the only viable treatment option; however, there are challenges associated with THA in this population, primarily the equalization of leg lengths. Here, we present two cases of Legg-Calve-Perthes disease treated via total hip arthroplasty with the assistance of an imageless, computer-assisted navigation device. In each case, the device provided intraoperative data on leg length in real time, allowing for improved accuracy of component placement. Postoperative leg lengths were confirmed to be equalized in each case using radiographs. These cases are, to our knowledge, the first such cases using imageless navigation during THA and demonstrate the benefits of such assistive technologies in challenging cases such as Legg-Calve-Perthes disease.
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Masrouha KZ, Callaghan JJ, Morcuende JA. Primary Total Hip Arthroplasty for Legg-Calvé-Perthes Syndrome: 20 Year Follow-Up Study. THE IOWA ORTHOPAEDIC JOURNAL 2018; 38:197-202. [PMID: 30104945 PMCID: PMC6047381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Patients with Legg-Calvé-Perthes Syndrome (LCPS) are at an increased risk for developing osteoarthritis of the hip and undergoing total hip arthroplasty (THA) at an early age. Importantly, this younger age may put them at a higher risk for failure and revision surgery. The purpose of the study was to assess the clinical and radiographic outcomes as well as implant failure rate and risk for revision surgery at an average 20 years follow up. METHODS Data from LCPS patients treated with THA were collected including age, gender, operative date, revision date, as well as reason for and type of revision. Living patients filled the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires at the time of last follow-up. Radiographs were evaluated for lucencies, debonding, loosening, osteolysis, wear, heterotopic ossification and sclerosis. RESULTS Nineteen patients (20 hips) treated with THA were followed-up for a mean of 18.3 years (range, 10.1 - 36.2 years). Radiographic evidence of lucency of the acetabular component was seen in 70% of the patients and femoral cortical hypertrophy in 85% at last follow-up. The rate of revision for any reason was 35%, mostly due to aseptic acetabular loosening. CONCLUSIONS Our findings support the use of THA for the treatment of OA in patients with LCPS, bearing in mind the potentially lower survival rate at 20 years as compared those treated with THA for primary OA. Further studies are needed to identify the possible causes of the high rate of cortical hypertrophy seen in this patient population.Level of Evidence: IV Therapeutic.
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Affiliation(s)
- Karim Z Masrouha
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, NY, U.S.A
| | - John J Callaghan
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, U.S.A
| | - José A Morcuende
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, U.S.A
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Luo ZY, Wang HY, Wang D, Pan H, Pei FX, Zhou ZK. Monobloc implants in cementless total hip arthroplasty in patients with Legg-Calve-Perthes disease: a long-term follow-up. BMC Musculoskelet Disord 2017; 18:386. [PMID: 28870190 PMCID: PMC5584027 DOI: 10.1186/s12891-017-1748-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/30/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate 10-year outcomes in cementless monobloc total hip arthroplasty (THA) in a group of hips with Legg-Calve-Perthes disease (LCPD). METHODS We reviewed 71 patients (88 hips) who underwent cementless THA with a diagnosis of LCPD from 2003 to 2009. From the total of 71 patients, 34 men and 37 women with an average age of 49.94 years were included. The mean follow-up period was 10 years. RESULTS The mean Harris Hip Score improved significantly from 46.42 to 89.70. Similarly, the postoperative range of motion, hip dysfunction and osteoarthritis outcome score and SF-12 score also significantly improved. The mean leg lengthening was 22.1 mm. During the follow-up, eight complications were noted, including two cases of intraoperative femoral fractures, two cases of sciatic nerve paralysis, two cases of heterotrophic ossifications, one case of thigh pain and one case of dislocation. One revision was conducted for a periprosthetic fracture, and the survivorship at 10 years was 98.3%. CONCLUSIONS These data suggest that the monobloc stem can lead to satisfactory outcomes for clinical function, radiological evaluation, restoration of the normal limb lengths, complications, and survivorship among LCPD patients undergoing total hip arthroplasty.
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Affiliation(s)
- Ze-Yu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Hao-Yang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Duan Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Hui Pan
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Fu-Xing Pei
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, 610041, People's Republic of China.
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12
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Hanna SA, Sarraf KM, Ramachandran M, Achan P. Systematic review of the outcome of total hip arthroplasty in patients with sequelae of Legg-Calvé-Perthes disease. Arch Orthop Trauma Surg 2017; 137:1149-1154. [PMID: 28674737 DOI: 10.1007/s00402-017-2741-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 11/30/2022]
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.
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Affiliation(s)
- Sammy A Hanna
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK.
| | - Khaled M Sarraf
- St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, UK
| | - Manoj Ramachandran
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
| | - Pramod Achan
- The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
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13
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Lee KH, Jo WL, Ha YC, Lee YK, Goodman SB, Koo KH. Total hip arthroplasty using a monobloc cementless femoral stem for patients with childhood Perthes’ disease. Bone Joint J 2017; 99-B:440-444. [DOI: 10.1302/0301-620x.99b4.bjj-2016-0259.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/07/2016] [Indexed: 11/05/2022]
Abstract
Aims Modular or custom-made femoral components have been preferred for total hip arthroplasty (THA) in patients with a history of Perthes’ disease because of the distortion in the anatomy of the proximal femur. However, it has not been established whether a monobloc cementless stem will fit the distorted proximal femur or whether the results of the procedure are satisfactory in this group of patients. Patients and Methods We reviewed 68 consecutive patients who had undergone THA for childhood Perthes’ disease between June 2003 and December 2008. There were 35 men and 33 women with a mean age of 48 years (16 to 73) at the time of index arthroplasty. Their mean body mass index was 24.4 (18.3 to 32.9). Of the 68 hips, 32 were classified as Stulberg class III and 36 as class IV. The mean pre-operative shortening of the affected leg was 17.2 mm (5 to 34). The minimum follow-up was five years (mean 8.5 years; 5.2 to 10). Results An intra-operative calcar fracture occurred in eight hips (11.8%) and was successfully treated by cerclage wiring. The mean stem version was 14.6° (-2.3 to 30; standard deviation (sd) 7.3). The mean acetabular component abduction was 40.2° (23.7 to 56.0; sd 6.5) and the mean anteversion 28.3° (6.4 to 43.0; sd 7.6), respectively. The mean follow-up was 8.5 years (5.2 to 10). No dislocations occurred and no hips were revised during the course of the study. At final follow-up, the mean Harris Hip Score was 91 points (59 to 100) and the mean University of California, Los Angeles activity score was 3.2 (2 to 8). Conclusion Monobloc cementless stems reliably restore the anatomy in Perthes’ disease at THA without the need for custom-made or modular implants. Cite this article: Bone Joint J 2017;99-B:440–444.
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Affiliation(s)
- K. H. Lee
- National Medical Center, 245, Eulji-ro, Jung-gu, Seoul, South
Korea
| | - W-L. Jo
- The Catholic University of Seoul St. Mary’s
Hospital, 222, Banpo-daero, Seocho-gu, Seoul
06591, South Korea
| | - Y. C. Ha
- Chung-Ang University Hospital, 102
Heukseok-ro, Dongjak-gu, Seoul, South
Korea
| | - Y. K. Lee
- Seoul National University, Bundang
Hospital, 166 Gumi-ro, Bundang-gu, Seongnam
463-707, South Korea
| | - S. B. Goodman
- Joint Replacement Center, 450
Broadway St Pavilion A 1st Fl MC 6110 Redwood City, CA94063, USA
| | - K. H. Koo
- Seoul National University, Bundang
Hospital, 166 Gumi-ro, Bundang-gu, Seongnam
463-707, South Korea
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14
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Karimi MT, Nodoshan SMM. Evaluation of the bone mineral density of the subjects with avascular necrosis of hip joint. CLINICAL CASES IN MINERAL AND BONE METABOLISM 2016; 13:141-143. [PMID: 27920812 DOI: 10.11138/ccmbm/2016.13.2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The head of femur is deformed in subjects with Leg Calve Perthes Disease (LCPD). It may be due to an increase in loads applied on the hip, decrease in hip joint containment and decrease in bone mineral density (BMD) of femur. Unfortunately there is not enough evidence regarding BMD of femur in subjects with LCPD. Therefore, the aim of this study is to evaluate BMD in subjects with Perthes disease. METHOD Two subjects with LCPD participated in this study. The BMD and Young modulus of elasticity (E) of different parts of femur of both Perthes and sound sides were evaluated by use of Mimics software. The difference between BMD of femur in both sides of each subject was compared by use of two sample t test. RESULTS There was no difference between the BMD and E modulus of femur in Perthes and sound sides in both subjects (p-value>0.05). CONCLUSION As there is no difference between the BMD of femur in Perthes side, it can be concluded that the deformation of femur in these subjects may not be due to a change in BMD.
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Affiliation(s)
- Mohammad Taghi Karimi
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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15
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Lee SJ, Yoo JJ, Kim HJ. Alumina-alumina total hip arthroplasty for the sequelae of Legg-Calve-Perthes disease: A comparative study with adult-onset osteonecrosis. J Orthop Sci 2016; 21:836-840. [PMID: 27522609 DOI: 10.1016/j.jos.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/14/2016] [Accepted: 07/13/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) for sequelae of Legg-Calve-Perthes disease (LCPD) involves specific concerns for deformity, leg length discrepancy (LLD), and relatively young age. Excellent long-term outcome has been proven after Alumina-Alumina (Al-Al) THA for relatively young patients, however, there was no study for Al-Al THA for LCPD sequelae. The aim of this study is to evaluate the results of Al-Al THA for LCPD sequelae and to compare the results with those for adult-onset ONFH, in which THA is necessitated in relatively young age and excellent long term outcome has been proven after Al-Al THA. METHODS Between 1997 and 2007, 41 Al-Al THA were performed in 37 patients with LCPD sequelae and followed-up for mean 10.4 years. Mean age at THA was 43.6 years. Using the propensity score matching, 41 THAs in 37 patients were identified from 339 hips in 256 patients with ONFH. The medical record and radiographic data was retrospectively reviewed. RESULTS During follow-up, no revision was performed in both group. Harris Hip Score increased from 66.7 ± 17.4 points to 96.8 ± 6.8 points in LCPD group and from 47.9 ± 18.4 to 96.6 ± 4.6 in ONFH group. LLD decreased significantly from 2.0 ± 1.2 cm to 0.2 ± 0.9 cm in LCPD group and from 0.5 cm to 0.1 cm in ONFH group. Postoperative LLD showed no difference in both groups. As for complication, rate of intraoperative femoral fracture was significantly higher in LCPD group than in ONFH group. Other postoperative complication showed no difference. CONCLUSIONS Despite the higher rate of intraoperative femoral crack, outcomes of Al-Al THA for LCPD were comparable to those for ONFH. Similar to ONFH, Al-Al THA may be a reliable treatment option for LCPD.
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Affiliation(s)
- Soong Joon Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, 20, Boramae-ro-5-gil, Dongjak-gu, Seoul 070601, Republic of Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Medical Research Center, Seoul National University, 103 Daehak-ro, Jongno-gu Seoul 03080, Republic of Korea
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16
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Seufert CR, McGrory BJ. Treatment of Arthritis Associated With Legg-Calve-Perthes Disease With Modular Total Hip Arthroplasty. J Arthroplasty 2015; 30:1743-6. [PMID: 25979188 DOI: 10.1016/j.arth.2015.04.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 02/01/2023] Open
Abstract
Legg-Calve-Perthes (LCP) disease can result in morphological deformities and associated adult hip arthritis. Thirty-five consecutive total hip arthroplasties (THA) were performed in 28 patients with a history of LCP using a non-cemented modular femoral component. There was one revision for late hematogenous infection and no evidence of prosthesis failure. Harris hip scores, on average, improved from 49.8 (26-73) to 93.9 (82-100) (P<0.05) after a minimum of 2 years follow-up (average, 8.2 years, range 2-14 years). Clinically, patients demonstrated diminished or no limping (94%, 33/35) and improved leg length equality post-operatively (100%, 35/35). This style of stem accommodated metaphyseal/diaphyseal size mismatch in 80% (28/35), allowed for abnormal anteversion in 71% (25/35), and resulted in radiographic improvements in trochanteric height (P<0.05), body weight lever arm (P<0.05), and leg length (P<0.05).
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Affiliation(s)
| | - Brian J McGrory
- Tufts University School of Medicine, Maine Medical Partners Orthopedics, Division of Joint Replacements, Falmouth, Maine
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17
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Lim YW, Kim MJ, Lee YS, Kim YS. Total Hip Arthroplasty in Patient with the Sequelae of Legg-Calvé-Perthes Disease. Hip Pelvis 2014; 26:214-9. [PMID: 27536584 PMCID: PMC4971396 DOI: 10.5371/hp.2014.26.4.214] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/24/2014] [Accepted: 12/08/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose Patients who have secondary hip osteoarthritis as sequelae of Legg-Calvé-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.
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Affiliation(s)
- Young Wook Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Jin Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Suk Lee
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Sik Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mazloumi SM, Ebrahimzadeh MH, Kachooei AR. Evolution in diagnosis and treatment of Legg-Calve-Perthes disease. THE ARCHIVES OF BONE AND JOINT SURGERY 2014; 2:86-92. [PMID: 25207324 PMCID: PMC4151449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 05/29/2014] [Indexed: 06/03/2023]
Abstract
Legg-Calvé-Perthes disease (LCPD) is an idiopathic osteonecrosis of the femoral head with variable complications and resultant deformity of the femoral head and osteoarthritis. Suggested risk factors are acetabular retroversion, obesity, latitude, hyperactivity, and coagulopathy. The most commonly applied classification is based on radiolucency in the lateral pillar of the femoral head, which is strongly correlated with the outcome. In the fragmentation stage of the disease involvement can be classified into three groups. After skeletal maturity, the outcome can be classified using the Stulberg classification based on the sphericity and congruence of the femoral head in relation to the acetabulum. The early goal of treatment is to prevent head deformation by weight transmitted forces during remodeling and ossification stages containment is the widely accepted principle of treatment. Although the Petrie cast still has a role in the short-term treatment of LCPD before and during the reossification stage, available data does not support additional benefits from braces during the course of LCPD.
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Affiliation(s)
- Seyed Mahdi Mazloumi
- Seyed Mahdi Mazloumi MD, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad H Ebrahimzadeh
- Seyed Mahdi Mazloumi MD, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Reza Kachooei
- Seyed Mahdi Mazloumi MD, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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