Total Hip Arthroplasty in Patient with the Sequelae of Legg-Calve´-Perthes Disease
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Patients who have secondary hip osteoarthritis as sequelae of Legg-Calve´-Perthes disease (LCPD) are severe deformities of femoral head and acetabulum. A few studies have presented that the clinical results and risks associated with total hip arthroplasty (THA) for patients with a history of LCPD were not satisfactory. Inthis study, we reported the radiographic and clinical outcomes of THA in patients with sequelae of LCPD. Materials and Methods: Between March 2007 and May 2012, 23 hips (23 patients) underwent cementless THA and were followed up at least 2 years after surgery. There were 11 male patients and 12 female patients with an average age of 49.2 years old (range, 25 to 69 years old), and the average follow up period was 40.8 months (range, 24 to 84 months). The clinical and radiological evaluations were performed. Results: The Harris hip score improved from 48.3 points preoperatively to 92.4 points at the time of the last follow-up. The shortening of affected limb was improved from –1.6 cm to 0.2 cm. The complications included one case of sciatic nerve palsy that developed after extensive lengthening of lower extremity, three cases of intraoperativefemur fractures. There was no component loosening. Conclusion: Fractures and motor nerve palsies may be more frequent in this population. Careful preoperative planning should be performed to overcome the technical pitfalls. If overcoming this early complication, the clinical and radiological evaluations showed excellent outcomes at average 40-month follow-ups.
Abstract
Purpose: Patients who have secondary hip osteoarthritis as sequelae of Legg-Calve´-Perthes disease (LCPD) are severe deformities of femoral head and acetabulum. A few studies have presented that the clinical results and risks associated with total hip arthroplasty (THA) for patients with a history of LCPD were not satisfactory. Inthis study, we reported the radiographic and clinical outcomes of THA in patients with sequelae of LCPD. Materials and Methods: Between March 2007 and May 2012, 23 hips (23 patients) underwent cementless THA and were followed up at least 2 years after surgery. There were 11 male patients and 12 female patients with an average age of 49.2 years old (range, 25 to 69 years old), and the average follow up period was 40.8 months (range, 24 to 84 months). The clinical and radiological evaluations were performed. Results: The Harris hip score improved from 48.3 points preoperatively to 92.4 points at the time of the last follow-up. The shortening of affected limb was improved from –1.6 cm to 0.2 cm. The complications included one case of sciatic nerve palsy that developed after extensive lengthening of lower extremity, three cases of intraoperativefemur fractures. There was no component loosening. Conclusion: Fractures and motor nerve palsies may be more frequent in this population. Careful preoperative planning should be performed to overcome the technical pitfalls. If overcoming this early complication, the clinical and radiological evaluations showed excellent outcomes at average 40-month follow-ups.
참고문헌 (26)
- Gower WE, "Legg-Perthes disease. Longterm follow-up of thirty-six patients", J Bone Joint Surg Am, 5, pp.759~768 (1971)
- Kelly FB Jr, "Legg-Calve´-Perthes disease. Long-term evaluation of non-containment treatment", J Bone Joint Surg Am, 62, pp.400~407 (1980)
- Stulberg SD, "The natural history of Legg-Calve´-Perthes disease", J Bone Joint Surg Am, 63, pp.1095~1108 (1981)
- Catterall A, "The natural history of Perthes’ disease", J Bone Joint Surg Br, 53, pp.37~53 (1971)
- Larson AN, "A prospective multicenter study of Legg-Calve´-Perthes disease:functional and radiographic outcomes of nonoperative treatment at a mean follow-up of twenty years", J Bone Joint Surg Am, 94, pp.584~592 (2012)
- Al-Khateeb H, "Custom cementless THA in patients with Legg-Calve´-Perthes Disease", J Arthroplasty, 29, pp.792~796 (2014)
- Baghdadi YM, "Total hip arthroplasty for the sequelae of Legg-Calve´-Perthes disease", Clin Orthop Relat Res, 471, pp.2980~2986 (2013)
- Radl R, "Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthrosis", Acta Orthop, 76, pp.49~55 (2005)
- Saito S, "Long-term results of total hip arthroplasty for osteonecrosis of the femoral head. A comparison with osteoarthritis", Clin Orthop Relat Res, 244, pp.198~207 (1989)
- Gent E, "Joint replacement for sequelae of childhood hip disorders", J Pediatr Orthop, 24, pp.235~240 (2004)
- Sankar WN, "The development of acetabular retroversion in children with Legg-Calve´-Perthes disease", J Pediatr Orthop, 28, pp.440~443 (2008)
- Kawasaki M, "Total hip arthroplasty after failed transtrochanteric rotational osteotomy for avascular necrosis of the femoral head", J Arthroplasty, 20, pp.574~579 (2005)
- Kim YS, "Modified posterior approach to total hip arthroplasty to enhance joint stability", Clin Orthop Relat Res, 46, pp.294~299 (2008)
- Harris WH, "Preliminary report of results of Harris total hip replacement", Clin Orthop Relat Res, 95, pp.168~173 (1973)
- Gruen TA, "“Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening", Clin Orthop Relat Res, 141, pp.17~27 (1979)
- Engh CA, "Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results", J Bone Joint Surg Br, 69, pp.45~55 (1987)
- Callaghan JJ, "Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to fiveyear follow-up", J Bone Joint Surg Am, 67, pp.1074~1085 (1985)
- Dorr LD, "Bilateral total hip arthroplasty comparing hydroxyapatite coating to porouscoated fixation", J Arthroplasty, 13, pp.729~736 (1998)
- DeLee JG, "Radiological demarcation of cemented sockets in total hip replacement", Clin Orthop Relat Res, 121, pp.20~32 (1976)
- Ranawat CS, "Correction of limb-length inequality during total hip arthroplasty", J Arthroplasty, 16, pp.715~720 (2001)
- Traina F, "Long-term results of total hip replacement in patients with Legg-Calve´-Perthes disease", J Bone Joint Surg Am, 93, pp.e25~ (2011)
- Takenaga RK, "Cementless total hip arthroplasty in patients fifty years of age or younger: a minimum ten-year follow-up", J Bone Joint Surg Am, 94, pp.2153~2159 (2012)
- Farrell CM, "Motor nerve palsy following primary total hip arthroplasty", J Bone Joint Surg Am, 87, pp.2619~2625 (2005)
- Bargar WL, "Shape the implant to the patient. A rationale for the use of custom-fit cementless total hip implants", Clin Orthop Relat Res, 249, pp.73~78 (1989)
- Upadhyay SS, "Femoral anteversion in Perthes’ disease with observations on irritable hips. Application of a new method using ultrasound", Clin Orthop Relat Res, 209, pp.70~76 (1986)
- Toni A, "Computer-assisted tridimensional preoperative planning in hip revision surgery", Chir Organi Mov, 88, pp.273~280 (2003)