Alumina-Alumina Total Hip Arthroplasty for sequelae of Legg-Calve-Perthes Disease: A Comparative Study with Adult-onset Osteonecrosis

Abstract

Total hip arthroplasty for Legg-Calve-Perthes disease (LCPD) needs specific concerns for deformity, leg length discrepancy (LLD), and relatively young age. To date, there was no study for Alumina-Alumina (Al-Al) THA for LCPD, even excellent long-term outcome has been documented, and no comparative study of THA for LCPD with that for adult-onset osteonecrosis of femoral head (ONFH), in which THA is necessitated in relatively young age and excellent long-term outcome has been proven after Al-Al THA. The aims of this retrospective study are to evaluate the clinical and radiological outcome and restoration of LLD after Al-Al THA for LCPD sequelae, to evaluate the occurrence of complication and to compare the result of THA for LCPD sequelae with that of THA for adult ONFH, by means of propensity scoring matching. Between 1997 and 2007, 41 Al-Al THA were performed in 37 patients with LCPD with minimum 5 years of follow-up. Mean age at THA was 43.6 years. Using the propensity score matching, 41 THAs in 37 patients were identified from 339 hips in 256 patients with THA for ONFH. Implant survival, Harris hip score (HHS), LLD change, and perioperative complication were compared between the two groups. There was no revision during follow-up period without osteolysis or loosening. HHS increased from 70.9±12.9 points to 97.4±5.4 points (p<0.001). LLD decreased from 2.0±1.2cm to 0.2±0.9cm. (p<0.001) Fourteen intraoperative femoral cracks occurred in LCPD group. Both groups showed no difference in implant survival and postoperative complication rate, however, LCPD group showed higher rate of intraoperative femoral fracture than ONFH group. Although high rate of intraoperative femoral crack was observed, outcomes of Al-Al THA for LCPD were comparable to those for ONFH. As with ONFH, Al-Al THA may be a reliable treatment option for LCPD sequelae.