Abstract
A minority of adult patients with childhood Legg–Calve–Perthes disease (LCPD) will
develop secondary arthritis with marked leg length discrepancy (LLD) and multiplanar
hip deformity. During total hip arthroplasty (THA), these technical challenges increase
the perioperative risks of nerve injury, leg length inequality, and implant malposition.
The technique of direct anterior total hip arthroplasty (DA-THA) in combination with
fluoroscopic imaging was evaluated to mitigate these risks. We performed a retrospective
review of 11 DA-THA procedures performed for patients with LCPD. The mean preoperative
LLD for the patient cohort was 17 mm (range, 2–54). The mean postoperative LLD was
6 mm (range, 0–28). Acetabular component orientation was precise and accurate with
a mean abduction angle of 44 degrees (range, 42–46) and mean anteversion of 20 degrees
(range, 16–24). Clinical outcomes demonstrated a mean hip disability and osteoarthritis
outcome score for joint replacement (HOOS, Jr) of 94 points. No patients had leg lengthening
more than 26 mm and no nerve palsies were identified. We conclude that DA-THA with
fluoroscopic guidance may be a valuable method to improve component placement precision
and procedural safety in this potentially high-risk patient group.
Keywords
Legg–Calve–Perthes disease - total hip replacement - anterior approach - fluoroscopy
- nerve palsy - leg length discrepancy
