JOA - 2026-05-05 - Journal Article
Total Hip Arthroplasty in Legg-Calve-Perthes Disease: Mean Nine-Year Outcomes of 201 Hips.
Restrepo DJ, Chen AG, Guarin Perez SF, Tai TW, Trousdale RT, Mabry TM, Sierra RJ
Topics
Key Takeaway
THA for LCPD achieves 99% aseptic revision-free survivorship at 15 years, but carries a 5% sciatic neuropraxia rate despite mean limb lengthening of only 15mm.
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Summary
This single-center retrospective series evaluated 201 THAs performed for LCPD between 2000 and 2020 to define contemporary survivorship and complication rates. At 15 years, aseptic revision-free survivorship was 99%, any-revision survivorship 98%, and reoperation-free survivorship 95%. Complications occurred in 30 hips (15%), most frequently sciatic neuropraxia (n=10) and intraoperative fracture (n=9); mean HHS improved from 55 to 92 at 10 years.
Key Limitation
Retrospective single-center design with no standardized nerve monitoring protocol limits ability to identify modifiable risk factors for the 5% sciatic neuropraxia rate.
Original Abstract
BACKGROUND
Legg-Calvé-Perthes (LCPD) disease is an uncommon, but challenging indication for total hip arthroplasty (THA). We aim to report one of the largest single-center contemporary series of THA associated with this condition.
METHODS
We reviewed 201 THAs for LCPD performed at a single institution between 2000 and 2020. The mean age at surgery was 47 years, the mean body mass index was 32 and 74% were men. Bearing surfaces included ceramic-on-highly-cross-linked polyethylene(C-HXLPE) in 95 hips (47%), metal-on-HXLPE in 83 hips (41%), ceramic-on-ceramic(CoC) in 17 hips (9%), and metal-on-metal(MoM) in six hips (3%). All acetabular components were cementless. Cementless and cemented femoral stems were used in 188 (93%) and 14 hips (7%), respectively. The mean follow-up was nine years (range, two to 22).
RESULTS
At 15 years, survivorships free of aseptic revision, any revision, and any reoperation were 99, 98, and 95% respectively. Indications for revision were infection (n=2), postoperative fracture (n=1), and metallosis (n=1). There were no significant differences in survivorship between hips with prior surgical treatment of LCPD (n=8) and those without (n=153). Complications occurred in 30 hips, most commonly sciatic neuropraxia (n=10) and intraoperative fracture (n=9). Preoperatively, patients had a mean leg-length discrepancy of 18mm shorter on the operative limb. Postoperatively, the operative limb was lengthened by a mean of 15mm. There was no difference in mean lengthening between patients who had sciatic neuropraxia and those who did not (12 versus 15mm; P=0.365). There were seven neuropraxias resolved, while three patients had persistent deficits at the latest follow-up. The mean Harris hip score (HHS) improved preoperatively from 55 to 92 at 10-year follow-up (P<0.0001).
CONCLUSION
At 15 years, patients who had LCPD undergoing contemporary THA showed excellent survivorship free of revision and reoperation. Surgeons should be aware that complications were not uncommon, especially sciatic neuropraxia and intraoperative fractures.