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Bone Joint J. 2017 Apr;99-B(4):440-444. doi: 10.1302/0301-620X.99B4.BJJ-2016-0259.R1.

Total hip arthroplasty using a monobloc cementless femoral stem for patients with childhood Perthes' disease.

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National Medical Center, 245, Eulji-ro, Jung-gu, Seoul, South Korea.
The Catholic University of Seoul St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul 06591, South Korea.
Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, South Korea.
Seoul National University, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam 463-707, South Korea.
Joint Replacement Center, 450 Broadway St Pavilion A 1st Fl MC 6110 Redwood City, CA94063, USA.



Modular or custom-made femoral components have been preferred for total hip arthroplasty (THA) in patients with a history of Perthes' disease because of the distortion in the anatomy of the proximal femur. However, it has not been established whether a monobloc cementless stem will fit the distorted proximal femur or whether the results of the procedure are satisfactory in this group of patients.


We reviewed 68 consecutive patients who had undergone THA for childhood Perthes' disease between June 2003 and December 2008. There were 35 men and 33 women with a mean age of 48 years (16 to 73) at the time of index arthroplasty. Their mean body mass index was 24.4 (18.3 to 32.9). Of the 68 hips, 32 were classified as Stulberg class III and 36 as class IV. The mean pre-operative shortening of the affected leg was 17.2 mm (5 to 34). The minimum follow-up was five years (mean 8.5 years; 5.2 to 10).


An intra-operative calcar fracture occurred in eight hips (11.8%) and was successfully treated by cerclage wiring. The mean stem version was 14.6° (-2.3 to 30; standard deviation (sd) 7.3). The mean acetabular component abduction was 40.2° (23.7 to 56.0; sd 6.5) and the mean anteversion 28.3° (6.4 to 43.0; sd 7.6), respectively. The mean follow-up was 8.5 years (5.2 to 10). No dislocations occurred and no hips were revised during the course of the study. At final follow-up, the mean Harris Hip Score was 91 points (59 to 100) and the mean University of California, Los Angeles activity score was 3.2 (2 to 8).


Monobloc cementless stems reliably restore the anatomy in Perthes' disease at THA without the need for custom-made or modular implants. Cite this article: Bone Joint J 2017;99-B:440-444.


Cementless; Monolithic; Perthes’ disease; Total hip arthroplasty

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