Total Hip Arthroplasty in Adults with Legg-Calvé-Perthes Disease
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Published:
Dec 20, 2023
Keywords:
Secondary hip osteoarthritis, Perthes disease, total hip arthroplasty, femoro-acetabular impingement
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Abstract
Objectives: To review the number of total hip replacements (THA) performed in our hospital, determine their aetiology and identify how many of them were performed for hip osteoarthritis secondary to Legg-Calvé-Perthes disease (LCPD).
Materials and Methods: We conducted a retrospective study reviewing all THA surgeries from 2008 to December 2021. We studied the preoperative radiographs, determining the aetiology of the osteoarthritis, laterality, sex and age of the patient at the time of surgery.
Results: We reviewed a total of 1103 hips in 935 patients. Primary hip osteoarthritis accounted for 81% of the cases. We gathered a total of 11 hips from 10 individuals (1%), with a mean age of 61 years, for hip osteoarthritis secondary to LCPD.
Conclusions: There is evidence that femoro-acetabular impingement (FAI), which results in early secondary hip osteoarthritis, may be influenced by changes in the growth of the proximal femoral physis or overgrowth of the greater trochanter, which are characteristics of LCPD. We believe that certain cases of “misclassified” primary hip osteoarthritis may have been incorrectly identified since no additional information was found to support the diagnosis of secondary hip osteoarthritis, hiding the potential of an alternate, evolved aetiology. Furthermore, we suggest monitoring young patients with LCPD after their growth is complete in order to detect early FAI and provide arthroscopic therapeutic options.
Materials and Methods: We conducted a retrospective study reviewing all THA surgeries from 2008 to December 2021. We studied the preoperative radiographs, determining the aetiology of the osteoarthritis, laterality, sex and age of the patient at the time of surgery.
Results: We reviewed a total of 1103 hips in 935 patients. Primary hip osteoarthritis accounted for 81% of the cases. We gathered a total of 11 hips from 10 individuals (1%), with a mean age of 61 years, for hip osteoarthritis secondary to LCPD.
Conclusions: There is evidence that femoro-acetabular impingement (FAI), which results in early secondary hip osteoarthritis, may be influenced by changes in the growth of the proximal femoral physis or overgrowth of the greater trochanter, which are characteristics of LCPD. We believe that certain cases of “misclassified” primary hip osteoarthritis may have been incorrectly identified since no additional information was found to support the diagnosis of secondary hip osteoarthritis, hiding the potential of an alternate, evolved aetiology. Furthermore, we suggest monitoring young patients with LCPD after their growth is complete in order to detect early FAI and provide arthroscopic therapeutic options.
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How to Cite
Marqueta González, P., Bueno Sánchez, A. M., Rodríguez del Real, T., & Lara Rubio, A. (2023). Total Hip Arthroplasty in Adults with Legg-Calvé-Perthes Disease. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(6), 647-652. https://doi.org/10.15417/issn.1852-7434.2023.88.6.1709
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Clinical Research
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References
1. Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am 1981;63(7):1095-108. PMID: 7276045
2. Kim YJ, Novais EN. Diagnosis and treatment of femoroacetabular impingement in Legg-Calvé-Perthes disease. J Pediatr Orthop 2011;31(2 Suppl):S235-40. https://doi.org/10.1097/BPO.0b013e3182260252
3. Uluçay C, Ozler T, Güven M, Akman B, Kocadal AO, Altıntaş F. Etiology of coxarthrosis in patients with total hip replacement. Acta Orthop Traumatol Turc 2013;47(5):330-3. https://doi.org/10.3944/aott.2013.3103
4. Heesakkers N, van Kempen R, Feith R, Hendriks J, Schreurs W. The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty-one years. Int Orthop 2015;39(5):859-63. https://doi.org/10.1007/s00264-014-2589-2
5. 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(8):1149-54. https://doi.org/10.1007/s00402-017-2741-8
6. Shohat N, Copeliovitch L, Smorgick Y, Atzmon R, Mirovsky Y, Shabshin N, et al. The long-term outcome after varus derotational osteotomy for Legg-Calvé-Perthes disease: A mean follow-up of 42 years. J Bone Joint Surg Am 20163;98(15):1277-85. https://doi.org/10.2106/JBJS.15.01349
7. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 2008;466(2):264-72. https://doi.org/10.1007/s11999-007-0060-z
8. Lee WY, Hwang DS, Ha YC, Kim PS, Zheng L. Outcomes in patients with late sequelae (healed stage) of Legg-Calvé-Perthes disease undergoing arthroscopic treatment: retrospective case series. Hip Int 2018;28(3):302-8. https://doi.org/10.5301/hipint.5000563
9. Amanatullah DF, Antkowiak T, Pillay K, Patel J, Refaat M, Toupadakis CA, et al. Femoroacetabular impingement: current concepts in diagnosis and treatment. Orthopedics 2015;38(3):185-99.
https://doi.org/10.3928/01477447-20150305-07
10. Nepple JJ, Fowler LM, Larson CM. Decision-making in the borderline hip. Sports Med Arthrosc Rev 2021;29(1):15-21. https://doi.org/10.1097/JSA.0000000000000298
11. Chiari C, Lutschounig MC, Nöbauer-Huhmann I, Windhager R. Femoroazetabuläres Impingement-Syndrom bei Adoleszenten – Wie beraten? Wie behandeln? [Femoroacetabular impingement syndrome in adolescents - How to adivse? How to treat?]. Orthopade 2022;51(3):211-8. [En alemán] https://doi.org/10.1007/s00132-022-04214-z
12. Vahedi H, Yacovelli S, Diaz C, Parvizi J. Surgical treatment of femoroacetabular impingement: Minimum 10-year outcome and risk factors for failure. JB JS Open Access 2021;6(4):e20.00176. https://doi.org/10.2106/JBJS.OA.20.00176
13. Masrouha KZ, Callaghan JJ, Morcuende JA. Primary total hip arthroplasty for Legg-Calvé-Perthes syndrome: 20 year follow-up study. Iowa Orthop J 2018;38:197-202. PMID: 30104945
2. Kim YJ, Novais EN. Diagnosis and treatment of femoroacetabular impingement in Legg-Calvé-Perthes disease. J Pediatr Orthop 2011;31(2 Suppl):S235-40. https://doi.org/10.1097/BPO.0b013e3182260252
3. Uluçay C, Ozler T, Güven M, Akman B, Kocadal AO, Altıntaş F. Etiology of coxarthrosis in patients with total hip replacement. Acta Orthop Traumatol Turc 2013;47(5):330-3. https://doi.org/10.3944/aott.2013.3103
4. Heesakkers N, van Kempen R, Feith R, Hendriks J, Schreurs W. The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty-one years. Int Orthop 2015;39(5):859-63. https://doi.org/10.1007/s00264-014-2589-2
5. 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(8):1149-54. https://doi.org/10.1007/s00402-017-2741-8
6. Shohat N, Copeliovitch L, Smorgick Y, Atzmon R, Mirovsky Y, Shabshin N, et al. The long-term outcome after varus derotational osteotomy for Legg-Calvé-Perthes disease: A mean follow-up of 42 years. J Bone Joint Surg Am 20163;98(15):1277-85. https://doi.org/10.2106/JBJS.15.01349
7. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 2008;466(2):264-72. https://doi.org/10.1007/s11999-007-0060-z
8. Lee WY, Hwang DS, Ha YC, Kim PS, Zheng L. Outcomes in patients with late sequelae (healed stage) of Legg-Calvé-Perthes disease undergoing arthroscopic treatment: retrospective case series. Hip Int 2018;28(3):302-8. https://doi.org/10.5301/hipint.5000563
9. Amanatullah DF, Antkowiak T, Pillay K, Patel J, Refaat M, Toupadakis CA, et al. Femoroacetabular impingement: current concepts in diagnosis and treatment. Orthopedics 2015;38(3):185-99.
https://doi.org/10.3928/01477447-20150305-07
10. Nepple JJ, Fowler LM, Larson CM. Decision-making in the borderline hip. Sports Med Arthrosc Rev 2021;29(1):15-21. https://doi.org/10.1097/JSA.0000000000000298
11. Chiari C, Lutschounig MC, Nöbauer-Huhmann I, Windhager R. Femoroazetabuläres Impingement-Syndrom bei Adoleszenten – Wie beraten? Wie behandeln? [Femoroacetabular impingement syndrome in adolescents - How to adivse? How to treat?]. Orthopade 2022;51(3):211-8. [En alemán] https://doi.org/10.1007/s00132-022-04214-z
12. Vahedi H, Yacovelli S, Diaz C, Parvizi J. Surgical treatment of femoroacetabular impingement: Minimum 10-year outcome and risk factors for failure. JB JS Open Access 2021;6(4):e20.00176. https://doi.org/10.2106/JBJS.OA.20.00176
13. Masrouha KZ, Callaghan JJ, Morcuende JA. Primary total hip arthroplasty for Legg-Calvé-Perthes syndrome: 20 year follow-up study. Iowa Orthop J 2018;38:197-202. PMID: 30104945