Total Hip Arthroplasty After Failed Treatment for Osteonecrosis of the Femoral Head (original) (raw)
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Osteonecrosis of the femoral head: the total hip replacement solution
The bone & joint journal, 2013
Symptomatic hip osteonecrosis is a disabling condition with a poorly understood aetiology and pathogenesis. Numerous treatment options for hip osteonecrosis are described, which include non-operative management and joint preserving procedures, as well as total hip replacement (THR). Non-operative or joint preserving treatment may improve outcomes when an early diagnosis is made before the lesion has become too large or there is radiographic evidence of femoral head collapse. The presence of a crescent sign, femoral head flattening, and acetabular involvement indicate a more advanced-stage disease in which joint preserving options are less effective than THR. Since many patients present after disease progression, primary THR is often the only reliable treatment option available. Prior to the 1990 s, outcomes of THR for osteonecrosis were poor. However, according to recent reports and systemic reviews, it is encouraging that with the introduction of newer ceramic and/or highly cross-l...
Short term outcome of primary un-cemented total hip arthroplasty in osteonecrosis of femoral head
International Journal of Research in Orthopaedics
Background: Osteonecrosis of femoral head (ONFH) is characterised by cell death in the subchondral bone caused by abnormalities of blood flow to the femoral head. About 5% to 13% of arthroplasties are performed yearly for ONFH in United States. Ficat and Arlet classification is the commonest system used for grading of ONFH. Advanced stages 3 and 4 are best managed with total hip arthroplasty (THA). THA restores hip range of movement and allows early ambulation in ONFH.Methods: After seeking approval from local institutional ethical committee 25 patients with stage 3 and stage 4 ONFH (Ficat and Arlet) were admitted from OPD of SKIMS MC and Hospital Bemina, Srinagar. The study was conducted from February 2018 to February 2020 in department of Orthopaedics SKIMS MC and Hospital Bemina, Srinagar. 25 patients with mean age of 50.64 years comprising of 13 females and 12 males with unilateral osteonecrosis of femoral head with collapsed head underwent uncemented total hip arthroplasty and...
Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2015
Total hip arthroplasty (THA) is a definitive option for end-stage osteonecrosis of the femoral head (ONFH). Historically, higher revision rates were observed in this population compared to THA for osteoarthritis (OA). This study provides a comprehensive evaluation of postoperative medical and surgical complications comparing THA in ONFH and OA at 90 days, 1 year, and 2 years after surgery. The PearlDiver database identified 45,002 OA and 8,429 ONFH patients who underwent THA. Mechanical complications (prosthetic loosening and osteolysis, implant failure), dislocation, renal and respiratory complications were significantly increased in the ONFH group within 2 years after THA. Pulmonary embolism rates where increased in younger ONFH patients within 2 years after THA. This data helps clinicians in the postoperative risk assessment of patients with ONFH.
Journal of Evolution of Medical and Dental Sciences, 2016
BACKGROUND Osteonecrosis of the femoral head is a progressive disease that generally affects patients in the third through fifth decade of life, if left untreated. Currently, 18% of all Total Hip Arthroplasty performed in USA are done for Osteonecrosis. (1) The aetiology for the Osteonecrosis varies from idiopathic, alcohol intoxication, steroid abuse or due to childhood hip disorders and hip trauma. We have selected 40 patients suffering from advanced femoral head osteonecrosis with subchondral collapse leading to Osteoarthritis of hip in young adults, treated by uncemented primary total hip replacement. This study is aimed to suggest that uncemented total hip arthroplasty can be applied predictably to this younger, potentially more active patient population. MATERIAL AND METHODS We have done 54 uncemented primary hips in 40 cases with mean follow-up of 5.5 years. The average age of the patient at the time of surgery was 43 years. All the hips are clinically and radiologically examined both pre-and post-operatively. All the cases are operated through postero-lateral approach and have used the fully Hydroxyapatite coated femoral straight stem designed for press fit insertion and hemispherical HA-coated cup inserted with press fit and in few cases we used an HA-coated screw. The patients are under regular follow-up. RESULTS All the patients are reviewed at 6 weeks, 3 months, 6 months and yearly thereafter. The clinical and functional status was recorded using the Harris Hip Score and WOMAC Hip Score. The mean Harris score has improved from an average of 44 points to an average of 93 points postoperatively; 94% showed good-to-excellent results, 2% of cases had shortening, one case developed hip dislocation after two weeks due to unguarded physiotherapy. CONCLUSION The short-term results of cementless total hip arthroplasty in patients with Osteonecrosis of the femoral head were encouraging. We await further follow-up to see if these promising results hold true.
Clinical Orthopaedics and Related Research, 2009
Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18–46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18–156 months). The mean preoperative Harris hip score was 44.7 points (range, 32–62 points) which improved to an average postoperative score of 80.1 points (range, 44–100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon. Level of Evidence: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
Joint-preserving procedures for osteonecrosis of the femoral head
EFORT Open Reviews
Osteonecrosis of the femoral head is a poorly understood condition that may lead to progressive destruction of the hip joint. Its incidence is common between the third and fifth decades of life and it is the diagnosis behind 5–18% of annually performed total hip arthroplasties (THAs) in the USA. Regarding the high rate of complications of THA in that age group, authors have agreed on the importance of joint-preservation techniques for this disease but techniques vary to establish a generally accepted algorithmic approach. Surgical head-preserving procedures, core decompression with or without graft, stem cell augmentation, or biologic adjuncts, vascularized bone grafting, and proximal femoral osteotomies have all been published on with heterogeneous results and with limited evidence to date. Consensus states that the prognosis of patients with osteonecrosis of the femoral head can be significantly improved with early diagnosis and timely intervention. Cite this article: EFORT Open R...
Conditions before collapse of the contralateral hip in osteonecrosis of the femoral head
Chang Gung medical journal, 2002
Osteonecrosis of the femoral head is a disease which may cause rapid femoral head collapse in relatively young patients. Clinical results of prosthesis replacement in osteonecrosis patients are generally poorer than in age-matched patients with other diagnoses. The ultimate goal in treating these patients is therefore to preserve not replace the involved femoral head. The purposes of this study were to analyze outcomes by examining osteonecrotic hips before collapse and to justify the role of early surgical intervention for osteonecrosis of the femoral head. Between 1993 and 1997, there were 275 consecutive patients with osteonecrosis of the femoral head who received joint replacement on 1 side. Among these patients, 100 contralateral hips with evidence of osteonecrosis in the stage before collapse were included in this study. Demographic information, laboratory data, and radiographs were reviewed and compared between patients whose collapse time was less than 1 year, between 1 and ...
Hip international : the journal of clinical and experimental research on hip pathology and therapy, 2017
Numerous salvage surgeries were popularised to halt the progression of hip osteonecrosis (ON). We aimed to compare the clinico-radiological outcomes of inverted femoral head graft (IFHG) versus standard core decompression (SCD) in treatment of nontraumatic hip ON at pre-arthritic stage. A case review was performed at a minimum 3 years follow-up of 61 patients (71 hips; mean age 32.96 (19-50) years; mean follow-up 7.86 (3-14) years; mean body mass index 28.58 (19-46); 32 males, 29 females) suffering nontraumatic hip ON at pre-arthritic stage. 38 hips underwent SCD and 33 IFHG. The outcome was assessed by changes in modified Harris Hip Score (MHHS), need for revision surgery and progression of modified Ficat-Arlet staging. Data were analysed including logistic regression and Kaplan-Meier survivorship analysis. 13/34 (38.2%) hips in SCD group were revised at 4.61 ± 2.61 years, while 7/33 (21.2%) in IFHG group at 8.43 ± 4.32 years (p = 0.023). MHHS was significantly higher in IFHG group...
Total hip arthroplasty for osteonecrosis
The Journal of Arthroplasty, 1999
A matched comparison was made between total hip arthroplasties done for osteonecrosis and those done for osteoarthritis. Patients were matched for age, sex, surgical approach, prosthesis, and surgeon. All received cemented Charnley replacements and had minimal follow-up of 10 years. There were 118 women and 70 men with a mean age of 58 years. Thirty-five patients were younger than 50. The mean follow-up was 17.8 years (range, 10 to 25.4 years). Revision rates for osteonecrosis and osteoarthritis were 18% and 19% (not significant). The mechanical failure rate (revision for loosening plus radiographic loosening) was greater, but not significantly so, in the osteonecrosis group. In patients younger than 50 years, the revision rate in osteonecrosis (50%) was significantly higher than that in any other group. Similarly, the mechanical failure rate in osteonecrosis was significantly greater in the patients younger than 50. Radiographic femoral loosening was greater in osteonecrosis at all follow-up intervals, and dislocations occurred more frequently in the osteonecrosis group than in the osteoarthritis group. Results of arthroplasty in both groups were comparable in patients over 50 years of age, although patients with osteonecrosis had an increased rate of dislocation. Patients with osteonecrosis who are younger than 50 years have a significantly higher rate of mechanical failure than those with osteoarthritis who are younger than 50 years. Cemented total hip arthroplasty should be recommended in this group with caution if at all.