Arthroscopy may improve Harris Hip Scores in patients with Legg-Calve-Perthes sequelae

SAN FRANCISCO — Arthroscopy can play a role in the management of painful sequelae resulting from Legg-Calve-Perthes disease, according to a study presented here.

J.W. Thomas Byrd, MD, shared his findings at the 2011 Annual Meeting of the Arthroscopy Association of North America.

A common childhood disorder, Legg-Calve-Perthes disease can lead to painful sequelae in adulthood that leaves the physician with few options outside of arthroplasty, investigators noted.

Byrd's study – one of the largest reported series of its kind – found arthroscopy can lead to the reduction of symptoms and improved quality of life in patients with the condition. However, Byrd also said the findings do not suggest that arthroscopy can alter “the natural history of the disease process.”

Byrd and his team investigated 20 consecutive patients with Legg-Calve-Perthes disease who underwent hip arthroscopy for their symptoms and had a minimum 2-year follow-up. The group had an average age of 26 years, and included 13 men and seven women. The investigators prospectively assessed the patients using a modified Harris Hip Score at 3, 6, 12, 24, 60, 120 and 180 months.

With an average follow-up of 56 months, the cohort displayed findings in arthroscopy that included:

16 labral tears;
15 hypertrophic or torn ligamentum teres;
seven femoral and six acetabular chondral lesions;
five loose bodies;
three osteochondral defects; and
one cam lesion.

The investigators found Harris Hip Scores improved, Byrd said, noting an average improvement of 25.3 points (from a preoperative score of 56.7 points to a postoperative 82 points). All patients in the cohort improved, but Byrd added that improvement was “negligible” in two patients who underwent repeat arthroscopy.

“In general these results were highly favorable … with minimum morbidity,” Byrd concluded. “The palliative benefits are quite evident, I think, although it is unlike that we are altering the natural history of this process, where these patients are eventually going to wind up being adults with early-onset osteoarthritis.”

Reference:

Byrd JWT, et al. Hip arthroscopy for Legg-Calve-Perthes Disease: Minimum 2-year follow-up. Paper SS-42. Presented at the 2011 Annual Meeting of the Arthroscopy Association of North America. April 14-16. San Francisco.

Disclosure: Byrd is a paid consultant for Smith & Nephew and A2 Surgical; receives research support from Smith & Nephew; is on the editorial/governing board for Arthroscopy; and is a board member or a committee appointment for the Arthroscopy Association of North America, the American Orthopaedic Society for Sports Medicine, the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine.

The very interesting part of this study is that, despite any radiologic classification and any radiologic evidence or angles measured, all patients basically had an improvement. I wonder if this changes your outlook on center-edge angles in other patients that do not have Perthes disease; that you would approach with lower center-edge angles because of these.

— Bojan B. Zoric, MD
Moderator

Disclosure: He is a paid consultant for and is on the speakers bureau or performs paid presentations for Smith & Nephew.

Follow OrthoSuperSite.com on Twitter