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.