Alberto Losa Sánchez, Ricardo Fernández Fernández, Luis Moraleda Novo, Luis Palacios Diaz, Gaspar González Morán, Ana Cruz Pardos
{"title":"Factors That Determine Pelvic Obliquity in Adults Who Suffered Legg-Calvé-Perthes Disease and the Role of Total Hip Arthroplasty in Its Restoration.","authors":"Alberto Losa Sánchez, Ricardo Fernández Fernández, Luis Moraleda Novo, Luis Palacios Diaz, Gaspar González Morán, Ana Cruz Pardos","doi":"10.1016/j.arth.2024.12.013","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The purpose of the study was to analyze the appearance of pelvic obliquity before total hip arthroplasty (THA) in adults who have Legg-Calvé-Perthes disease (LCPD) sequelae and its evolution in the first two postoperative years, identifying which factors influence its development.</p><p><strong>Methods: </strong>The THAs performed between 2012 and 2021 at a single institution in adults who had LCPD during childhood were retrospectively identified. Each case was matched 1:1, based on age at surgery, sex, and body mass index, with a primary THA performed for hip osteoarthritis (OA). A THA was implanted at a mean age of 47 years (range, 21 to 91), and 18 patients (64.3%) were men. We conducted a mean follow-up of 5.1 years (range, two to 10.1). Implant position, soft tissue balance, and pelvic obliquity were evaluated at 6 and 12 weeks and at 1 and 2 years. There were 28 THAs in 25 adults who suffered LCPD, and 28 THAs in patients who underwent surgery due to primary OA were included.</p><p><strong>Results: </strong>An increase in the initial pelvic obliquity at 6 weeks of THA was observed in both groups (from 3.6 ± 2.8 to 4 ± 3.2 and from 1.3 ± 1.2 to 1.8 ± 1.5, respectively), which progressively decreased at 12 weeks, 1 year, and 2 years after surgery, with final values of 2.2 ± 1.5 and 0.8 ± 0.7 for the LCPD and OA groups, respectively. Only in the LCPD group were the preoperative values associated with a greater limb length discrepancy (Rho = 0.41) and a lower femoral offset (Rho = -0.26) (P < 0.05).</p><p><strong>Conclusions: </strong>Patients who suffered LCPD in childhood have greater pelvic obliquity than those who have primary OA, and this is associated with greater limb length discrepancy and less femoral offset. In these patients, THA decreases pelvic obliquity 2 years after its implantation, although it increases in the first weeks, probably due to the shortening of the abductor muscles, so patients should be warned before surgery.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV (Case Series).</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arthroplasty","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arth.2024.12.013","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The purpose of the study was to analyze the appearance of pelvic obliquity before total hip arthroplasty (THA) in adults who have Legg-Calvé-Perthes disease (LCPD) sequelae and its evolution in the first two postoperative years, identifying which factors influence its development.
Methods: The THAs performed between 2012 and 2021 at a single institution in adults who had LCPD during childhood were retrospectively identified. Each case was matched 1:1, based on age at surgery, sex, and body mass index, with a primary THA performed for hip osteoarthritis (OA). A THA was implanted at a mean age of 47 years (range, 21 to 91), and 18 patients (64.3%) were men. We conducted a mean follow-up of 5.1 years (range, two to 10.1). Implant position, soft tissue balance, and pelvic obliquity were evaluated at 6 and 12 weeks and at 1 and 2 years. There were 28 THAs in 25 adults who suffered LCPD, and 28 THAs in patients who underwent surgery due to primary OA were included.
Results: An increase in the initial pelvic obliquity at 6 weeks of THA was observed in both groups (from 3.6 ± 2.8 to 4 ± 3.2 and from 1.3 ± 1.2 to 1.8 ± 1.5, respectively), which progressively decreased at 12 weeks, 1 year, and 2 years after surgery, with final values of 2.2 ± 1.5 and 0.8 ± 0.7 for the LCPD and OA groups, respectively. Only in the LCPD group were the preoperative values associated with a greater limb length discrepancy (Rho = 0.41) and a lower femoral offset (Rho = -0.26) (P < 0.05).
Conclusions: Patients who suffered LCPD in childhood have greater pelvic obliquity than those who have primary OA, and this is associated with greater limb length discrepancy and less femoral offset. In these patients, THA decreases pelvic obliquity 2 years after its implantation, although it increases in the first weeks, probably due to the shortening of the abductor muscles, so patients should be warned before surgery.
Level of evidence: Therapeutic Level IV (Case Series).
期刊介绍：
The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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