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Osteonecrosis of the Femoral Head Treated with
Cementless Total Hip Arthroplasty

William T. Hartley, M.D., James P. Mc Auley, M.D., William J. Culpepper, M.S., C. Anderson Engh, Jr., M.D., Charles A. Engh, Sr., M.D

Abstract

Background: The treatment of young patients with osteonecrosis with collapse or significant secondary degeneration remains a therapeutic challenge -- with total hip arthroplasty being a treatment of choice. However, concerns about the durability of hip arthroplasty in this population necessitate long-term evaluation of this treatment option. To determine its advantages and limitations, our study evaluated the results of cementless total hip arthroplasty in a consecutive series of young patients with advanced osteonecrosis.

Methods: We reviewed fifty-five consecutive primary total hip arthroplasties (mean 117 month follow-up) in forty-five patients with a preoperative diagnosis of advanced osteonecrosis of the femoral head (Ficat and Arlet stage III or IV). Patients were an average age of thirty-one years (range, twenty-one to forty years) at operation. We collected data prospectively through patient questionnaires and radiographs.

Results: Five patients died and one patient was lost before the minimum five-year follow-up, leaving forty-eight hips in thirty-nine patients for review. Ten of forty-eight hips (21 per cent) required revision. Six of the ten revisions were due to polyethylene wear and osteolysis, which in one case resulted in acetabular loosening; three were secondary to recurrent dislocation; one was a resection of both components due to deep infection. No revisions were due to aseptic failure of the femoral component. Of the remaining twenty-nine patients (thirty-six hips), twenty-seven (93 per cent) reported no functional limitations, and twenty-three (79 per cent) could walk an unlimited distance. Pain was absent or mild in twenty-five patients (86 per cent). Twenty-three patients (79 per Radiographically, thirty-five femoral components (97 per cent) were bone ingrown with remaining components judged fibrous stable. All thirty-six acetabular components were considered bone ingrown.

Conclusions: Cementless total hip arthroplasty remains a reasonable treatment option for advanced osteonecrosis of the femoral head. Wear of the bearing surface continues to limit the long-term success rate, yet we are encouraged by the predictable, long-term stability of the bone-implant interface achieved with cementless fixation. These results compare favorably to published reports of cemented total hip arthroplasty in younger patients with osteonecrosis.

 

 

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