Hip resurfacing arthroplasty for end-stage arthritis caused by childhood hip disease.

Abstract

Patients with hip arthritis due to Legg-Calvé-Perthes (LCP) and slipped capital femoral epiphysis (SCFE) pose altered femoral anatomy, making hip resurfacing arthroplasty (HRA) technically complicated. We examined implant survival and clinical symptoms in patients with a history of LCP or SCPE who underwent HRA for end-stage osteoarthritis. Data was collected for patients who underwent HRA for osteoarthritis due to LCP (n = 59) or SCFE (n = 32). Harris Hip Scores (HHS), UCLA activity scores, and radiographs were evaluated pre and postoperatively. Wilcoxon Signed-Rank Tests and Kaplan-Meier Survivorship curves were used to analyse data. Survivorship for freedom from revision or clinical failure was 93.55(95% CI, 78.47-98.18) at 5.79 years, up until the most recent follow-up of 11.23 years. There were 3 failures: 1 LCP due to instability at 2.4 years, 1 SCFE due to femoral neck fracture at 1 month, and another SCFE due to unexplained pain at 5.8 years. Five patients, 1 LCP and 4 SCFE, had retained hardware prior to surgery; 4 had their hardware removed during surgery. Postoperatively HHS and UCLA activity scores increased (p < 0.0001, for both measures). Leg-length discrepancy improved preoperatively from 7.9 (0.0-32) mm to 0.65 (0.0-10) mm postoperatively (p < 0.0001). Follow-up radiographs of all non-failure HRA patients revealed implants to be in good alignment with no indication of loosening. Although HRA in SCFE and LCP patients increases technical difficulties, findings demonstrate excellent implant survival, no intraoperative complications, and improvements in leg-length discrepancies and clinical functional outcomes.