gms | German Medical Science

Objectives: Current surgical literature on total hip arthroplasty (THA) for pediatric hip disorders (PHD) is limited. This study provides a comprehensive review of several notable orthopedic conditions associated with impairment of the hip joint during childhood, eventually leading to THA in adolescence and adulthood.

We aimed at evaluating THA rates in children diagnosed with any of 12 notable PHD, including

1.

Legg-Perthes-Calvé Disease,

2.

Developmental Dysplasia of the Hip,

3.

Slipped Capital Femoral Epiphysis,

4.

neuromuscular hip dysplasia,

5.

post-traumatic avascular necrosis of the femoral head,

6.

juvenile rheumatoid arthritis,

7.

achondroplasia,

8.

spondyloepiphyseal dysplasia,

9.

mucopolysaccharidosis,

10.

mucolipidosis,

11.

hip septic arthritis, and

12.

tumors.

Methods: We screened over 3,666 studies and selected 61 articles following the PRISMA guidelines for systematic reviews. Selection criteria:

1.

diagnosis of any ofthe 12 notable PHD

2.

minimum follow-up > 16 months;

3.

assesment of clinical or radiological outcome scores;

4.

MINORS quality score > 9.

Results and conclusion: Clinical and radiological outcomes following THA for PHD are generally favorable, with all studies indicating improvements in hip pain and function. The majority of symptomatic prearthritic PHD patients undergo acetabular and femoral osteotomies, which, while delaying the need for THA, alter the joint's anatomy and subsequently complicate THA surgery.

The vast majority of THA are typically performed between the ages of 50 and 70, once osteoarthritis becomes symptomatic. A variety of implants are used, ranging from modular cementless to cemented hybrid THA for osteopenia. Custom prostheses are more frequently employed for conditions such as tumors, skeletal dysplasia, juvenile rheumatoid arthritis, and hip septic arthritis, which also necessitate THA earlier in life, typically before the age of 50 or 40. Regardless of the initial diagnosis, THA for PHD is associated with a higher risk of all-cause complications compared to THA in the general population. This includes higher revision rates, particularly for THA in adolescents and for diagnoses of spondyloepiphyseal dysplasia, mucopolysaccharidosis, mucolipidosis, and a history of septic arthritis. Despite these challenges, outcomes are generally positive.

Despite the diverse spectrum of PHD and the inherent higher risk of complications and revision, THA consistently demonstrates its efficacy in enhancing hip functionality, alleviating hip pain, and improving the overall quality of life regardless of the specific initial diagnosis. It is crucial to provide a comprehensive preoperative counseling to patients about the possibility of increased risk of complications and THA revision: data from this review can serve as a valuable resource for physicians in this purpose.