How are adults who had Perthes' disease functioning after total hip arthroplasty? : patient-reported outcome results from an international web-based survey.

Abstract

Aims: Perthes' disease is a hip disorder that presents in childhood but can lead to diminished quality of life (QoL) in adulthood from hip deformities and secondary arthritis. Little is known about adult outcomes following total hip arthroplasty (THA) from the patient's perspective. We employed a web-based survey to gather data on treatment history, demographic details, and patient-reported outcome measures (PROMs) from adults with Perthes' disease who underwent THA. We then compared these PROMs to those of age- and sex-matched normative cohorts, and a Perthes' disease cohort not treated with THA.

Methods: We used an English REDCap-based survey on a Perthes' disease study group website, which included Perthes' disease history, University of California, Los Angeles Activity Scale scores, the 36-Item Short-Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS). A total of 261 THA participants were analyzed (mean age at survey 44.6 years (SD 12.4); mean time since THA 7.2 yrs (SD 8.0)).

Results: Compared to normative cohorts, THA participants had significantly lower HOOS QoL and Sports & Recreation scores across all age groups (p < 0.001). Female THA participants aged under 45 years reported worse HOOS Pain, Symptom, and Activities of Daily Living scores, as well as SF-36 Physical and Social scales (all p < 0.001) compared to normative cohorts. Hip dysplasia and number of years from THA were significantly associated with poorer outcome. In comparison to a Perthes' disease cohort without THA, female THA participants aged 35 to 54 years reported significantly better outcomes across all scores except for sports. Females aged 18 to 34 years had significantly better symptom and pain scores in the THA cohort.

Conclusion: The Perthes' disease cohort who had THA had better pain and symptom scores than the Perthes' disease non-THA cohort, but reported substantially lower QoL scores compared to a normative population. These results highlight the symptom improvements that THA can offer, while suggesting the need for research to improve treatments which will reduce persisting impairments of QoL.