Medium-term outcomes of total hip arthroplasty in juvenile patients

Francesco Luceri,Nicola Maffulli,Alberto Della Grazia,Domenico Curci,Ilaria Morelli,Carlo Maria Sinicato,Fabio Verdoni,Giuseppe M Peretti

doi:10.1186/s13018-020-01990-2

Abstract

BackgroundJuvenile hip osteoarthritis is often the end result of congenital conditions or acquired hip ailments occurred during the paediatric age. This study evaluated the middle term results of total hip arthroplasty for end-stage juvenile hip osteoarthritis.Materials and methodsThis is a retrospective analysis of prospectively collected data on a cohort of 10 consecutive patients (12 hips), aged between 14 and 20 at operation, who underwent cementless total hip arthroplasty for end-stage juvenile secondary hip osteoarthritis in two orthopaedic tertiary referral centres between 2009 and 2018.ResultsJuvenile hip osteoarthritis occurred as a consequence of developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis. All patients showed a significant improvement in Harris Hip Score (p < 0.01) at 3.3 years average follow-up (range 0.7–10.1 years).ConclusionThe management of juvenile hip osteoarthritis following developmental dysplasia of the hip, Legg-Calvé-Perthes disease, femoral head necrosis or slipped capital femoral epiphysis is still challenging. Careful preoperative planning is essential to achieve good outcomes and improve the Harris Hip Score in these young patients. Total hip arthroplasty is a suitable option for end-stage secondary juvenile hip osteoarthritis, when proximal femoral osteotomies and conservative treatments fail to improve patients’ symptoms and quality of life.Level of evidenceIV

Highlights

Osteoarthritis of the hip may be the end result of congenital or acquired hip conditions occurred during the juvenile age [1]
This study evaluated the reliability of total hip arthroplasty (THA) in the management of end-stage juvenile hip osteoarthritis (JHOA)
Materials and methods With appropriate Institutional Review Board approval, we retrospectively reviewed all patients affected by endstage secondary JHOA who had undergone cementless THA between 2009 and 2018 at two major orthopaedic hospitals (Table 1)

Summary

Introduction

Osteoarthritis of the hip may be the end result of congenital or acquired hip conditions occurred during the juvenile age [1]. Predicting which child will need a salvage procedure remains a major challenge, but approximately 5% of the affected children will require a total hip arthroplasty (THA) [12]. There seems to be an increased risk of hip osteonecrosis after systemic glucocorticoid administration in young patients [13]. A strong association of AVN with high-dose glucocorticoid therapy has been reported in systemic diseases [15,16,17]. Juvenile hip osteoarthritis is often the end result of congenital conditions or acquired hip ailments occurred during the paediatric age. This study evaluated the middle term results of total hip arthroplasty for endstage juvenile hip osteoarthritis

Methods

Results

Discussion

Conclusion