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Scientific Articles   |    
Long-Term Results of Total Hip Replacement in Patients with Legg-Calvé-Perthes Disease
Francesco Traina, MD1; Marcello De Fine, MD1; Alessandra Sudanese, MD1; Pierina Paola Calderoni, MD1; Enrico Tassinari, MD1; Aldo Toni, MD1
1 1st Department of Orthopaedic Surgery, Istituti Ortopedici Rizzoli, Via Pupilli 1, Bologna 40136, Italy. E-mail address for F. Traina: traina@tecno.ior.it
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the 1st Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Apr 06;93(7):e25 1-7. doi: 10.2106/JBJS.J.00648
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Abstract

Background: 

Total hip replacement in patients with Legg-Calvé-Perthes disease can be difficult because of the multiplanar deformities of the proximal part of the femur and previous surgery during childhood. The aim of the present study was to assess the long-term outcomes of total hip replacement in patients who had Legg-Calvé-Perthes disease during childhood.

Methods: 

A retrospective study was carried out to assess the results of thirty-two total hip replacements that had been performed for twenty-seven patients from January 1989 to November 2004. The average age at the time of surgery was 37.8 years. The average duration of follow-up was 124 months (range, fifty-eight to 248 months). All but one of the implants were cementless.

Results: 

There was only one failure in the present study; specifically, the one cemented stem in the study failed two years after surgery. The cumulative survival rate at fifteen years was 96.9% (95% confidence interval, 90.8% to 100.0%). The overall rate of complications was 12.5%, with two permanent sciatic nerve palsies. At the time of the latest follow-up, the average Harris hip score was 87.5 (range, 73 to 96), which was a marked improvement in comparison with the preoperative score (average, 50.1; range, 25 to 75).

Conclusions: 

Despite the high rate of neurological complications, possibly related to excessive limb lengthening or inadequate soft-tissue release, total hip replacement can be considered a feasible option for patients with Legg-Calvé-Perthes disease. Careful preoperative planning is advisable in order to overcome the technical pitfalls related to the abnormal proximal femoral and acetabular anatomy of these patients.

Level of Evidence: 

Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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