Direct Anterior Total Hip Arthroplasty with Fluoroscopy to Mitigate the Risk of Complications in Patients with Legg–Calve–Perthes Disease

A minority of adult patients with childhood Legg–Calve–Perthes disease (LCPD) will develop secondary arthritis with marked leg length discrepancy (LLD) and multiplanar hip deformity. During total hip arthroplasty (THA), these technical challenges increase the perioperative risks of nerve injury, leg length inequality, and implant malposition. The technique of direct anterior total hip arthroplasty (DA-THA) in combination with fluoroscopic imaging was evaluated to mitigate these risks. We performed a retrospective review of 11 DA-THA procedures performed for patients with LCPD. The mean preoperative LLD for the patient cohort was 17 mm (range, 2–54). The mean postoperative LLD was 6 mm (range, 0–28). Acetabular component orientation was precise and accurate with a mean abduction angle of 44 degrees (range, 42–46) and mean anteversion of 20 degrees (range, 16–24). Clinical outcomes demonstrated a mean hip disability and osteoarthritis outcome score for joint replacement (HOOS, Jr) of 94 points. No patients had leg lengthening more than 26 mm and no nerve palsies were identified. We conclude that DA-THA with fluoroscopic guidance may be a valuable method to improve component placement precision and procedural safety in this potentially high-risk patient group.