Presented at the 2nd Annual Total Hip Resurfacing Arthroplasty Course in LA Oct. 2008
Metal-on-metal total hip resurfacing has been used as an alternative to conventional total hip arthroplasty, especially in younger patients, with multiple studies showing excellent short- and mid-term outcomes. Legg-Calvé-Perthes disease is characterized by an interruption to the blood supply of the femoral head, which often leads to osteoarthritis as well as various deformities of the proximal femur. The purpose of this report was to assess the results of resurfacing for patients who had Perthes disease.
We compared the clinical and radiographic outcomes of 18 patients (19 hips) who had Perthes disease and who underwent resurfacing to reports of similarly-aged patients who underwent conventional total hip arthroplasty. The patients who underwent resurfacing consisted of 10 men and 8 women who had a mean age of 33 years (range, 18 to 54 years). An anterolateral approach was used in three patients (four hips), and a posterior approach was used for the remaining 15 patients. Fifteen of the 19 hips had a coxa plana deformity, and a trochanteric slide advancement was performed to restore the femoral neck length prior to placement of the prosthesis. All of the patients were followed for a minimum of two years after the procedure, with assessments of Harris hip scores, range of motion, and radiographic outcomes.
The mean Harris hip score improved from 40 points (range, 16 to 68 points) preoperatively to 84 points (range, 53 to 98 points) at a mean final follow-up time of 51 months (range, 26 to 72 months). Eighteen of the 19 hips had Harris hip scores greater than 80 points. All patients improved their range of motion. Sixteen patients (16 hips) experienced improvements in leg length by a mean of 5 millimeters. One patient required a conversion to a conventional total hip arthroplasty for an aseptic loosening. The clinical success rate was comparable to reports of similarly-aged patients who underwent conventional total hip arthroplasty at similar follow-up times.
Hip resurfacing arthroplasty had excellent short-term success rates for Perthes disease, and the results were comparable to conventional total hip arthroplasty for young patients. The trochanteric advancement technique may be useful for restoring femoral neck length in this patient population. These procedures may be beneficial alternatives for patients who have femoral deformities as a result of Perthes disease.