Download PDF
The Journal of Hip Surgery 2021; 05(01): 020-024
DOI: 10.1055/s-0041-1723935
Original Article

Direct Anterior Total Hip Arthroplasty with Fluoroscopy to Mitigate the Risk of Complications in Patients with Legg–Calve–Perthes Disease

Andrew G. Yun
1   Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, California
,
Marilena Qutami
1   Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, California
,
Kory B. Dylan Pasko 
1   Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, California
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

A minority of adult patients with childhood Legg–Calve–Perthes disease (LCPD) will develop secondary arthritis with marked leg length discrepancy (LLD) and multiplanar hip deformity. During total hip arthroplasty (THA), these technical challenges increase the perioperative risks of nerve injury, leg length inequality, and implant malposition. The technique of direct anterior total hip arthroplasty (DA-THA) in combination with fluoroscopic imaging was evaluated to mitigate these risks. We performed a retrospective review of 11 DA-THA procedures performed for patients with LCPD. The mean preoperative LLD for the patient cohort was 17 mm (range, 2–54). The mean postoperative LLD was 6 mm (range, 0–28). Acetabular component orientation was precise and accurate with a mean abduction angle of 44 degrees (range, 42–46) and mean anteversion of 20 degrees (range, 16–24). Clinical outcomes demonstrated a mean hip disability and osteoarthritis outcome score for joint replacement (HOOS, Jr) of 94 points. No patients had leg lengthening more than 26 mm and no nerve palsies were identified. We conclude that DA-THA with fluoroscopic guidance may be a valuable method to improve component placement precision and procedural safety in this potentially high-risk patient group.

Keywords

Legg–Calve–Perthes disease - total hip replacement - anterior approach - fluoroscopy - nerve palsy - leg length discrepancy


Publication History

Received: 31 March 2020

Accepted: 10 December 2020

Article published online:
30 March 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Herring JA. The treatment of Legg-Calvé-Perthes Disease. A critical review of the literature. J Bone Joint Surg Am 1994; 76 (03) 448-458
    CrossrefPubMedGoogle Scholar
  • 2 Ippolito E, Tudisco C, Farsetti P. The long-term prognosis of unilateral Perthes' disease. J Bone Joint Surg Br 1987; 69 (02) 243-250
    CrossrefPubMedGoogle Scholar
  • 3 Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes Disease. J Bone Joint Surg Am 1981; 63 (07) 1095-1108
    CrossrefPubMedGoogle Scholar
  • 4 Froberg L, Christensen F, Pedersen NW, Overgaard S. The need for total hip arthroplasty in Perthes disease: a long-term study. Clin Orthop Relat Res 2011; 469 (04) 1134-1140
    CrossrefPubMedGoogle Scholar
  • 5 Traina F, De Fine M, Sudanese A, Calderoni PP, Tassinari E, Toni A. Long-term results of total hip replacement in patients with Legg-Calvé-Perthes Disease. J Bone Joint Surg Am 2011; 93 (07) e25
    CrossrefPubMedGoogle Scholar
  • 6 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 (08) 1149-1154
    CrossrefPubMedGoogle Scholar
  • 7 Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87 (12) 2619-2625
    CrossrefPubMedGoogle Scholar
  • 8 Lyman S, Lee Y-Y, Franklin PD, Li W, Mayman DJ, Padgett DE. Validation of the HOOS, JR: a short-form hip replacement survey. Clin Orthop Relat Res 2016; 474 (06) 1472-1482
    CrossrefPubMedGoogle Scholar
  • 9 Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 2005; 441 (441) 115-124
    CrossrefPubMedGoogle Scholar
  • 10 Eskildsen SM, Wilson ZJ, McNabb DC, Olcott CW, Del Gaizo DJ. Acetabular reconstruction with the medial protrusio technique for complex primary and revision total hip arthroplasties. J Arthroplasty 2017; 32 (11) 3474-3479
    CrossrefPubMedGoogle Scholar
  • 11 Edwards BN, Tullos HS, Noble PC. Contributory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop Relat Res 1987; (218) 136-141
    PubMedGoogle Scholar
  • 12 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 (01) 386
    CrossrefPubMedGoogle Scholar
  • 13 Baghdadi YM, Larson AN, Stans AA, Mabry TM. Total hip arthroplasty for the sequelae of Legg-Calvé-Perthes disease. Clin Orthop Relat Res 2013; 471 (09) 2980-2986
    CrossrefPubMedGoogle Scholar
  • 14 Shah RR, Gobin V, Muir JM. 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
    PubMedGoogle Scholar
  • 15 Krych AJ, Howard JL, Trousdale RT, Cabanela ME, Berry DJ. Total hip arthroplasty with shortening subtrochanteric osteotomy in Crowe type-IV developmental dysplasia: surgical technique. J Bone Joint Surg Am 2010; 92 (1, Suppl 1 Pt 2) 176-187
    CrossrefPubMedGoogle Scholar
  • 16 Seufert CR, McGrory BJ. Treatment of arthritis associated with Legg-Calve-Perthes Disease with modular total hip arthroplasty. J Arthroplasty 2015; 30 (10) 1743-1746
    CrossrefPubMedGoogle Scholar