Systematic review of the outcome of total hip arthroplasty in patients with sequelae of Legg-Calve-Perthes disease

Background Total hip arthroplasty (THA) in patients with sequelae of Legg-Calve-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.