J Korean Hip Soc.  2011 Dec;23(4):275-281. 10.5371/jkhs.2011.23.4.275.

Cementless Total Hip Arthroplasty Using a Modular Femoral Component in Patients with Femoral Head Osteonecrosis: Comparison of Metal-on-Metal and Ceramic-on-Ceramic Articulation

• Kang BJ
• Lee JH
• Jung YB
• Kim JH
• Han Y
• Jang EC
• Kim KW

• KMID: 1452635
• DOI: http://doi.org/10.5371/jkhs.2011.23.4.275

Abstract

PURPOSE
The purpose of this study was to evaluate the clinical and radiological outcomes after total hip arthroplasty using the S-ROM modular system for osteonecrosis of the femoral head, and to compare the results between the groups using metal-on-metal articulation and ceramic-on-ceramic articulation.
MATERIALS AND METHODS
Sixty-six patients (78 hips) with osteonecrosis of the femoral head were evaluated after primary total hip arthroplasty between January 2001 and December 2004, using an S-ROM proximal modular femoral stem. The average follow-up was 77 months (range, 60 to 122 months) and all patients were followed for more than five years.
RESULTS
The average Harris hip score improved from 53 points to 88.5 points at the final follow-up. At the latest radiologic evaluation, sixty-seven stems had bony ingrowth stability, and 10 stems had stable fibrous ingrowth. However, one stem had diffuse extensive osteolysis and loosening, which was revised at 9 years. Postoperative complications included 4 cases of heterotrophic ossificiation, 1 case of linear fracture after insertion of the femoral stem, 1 case of dislocation, 2 cases of infection, and 1 case of extensive osteolysis and loosening. There were 3 cases of revision and Kaplan-Meier survivorship analysis with revision estimated at a 95.7% chance of survival for the femoral component during 122 months.
CONCLUSION
Our study showed that total hip arthroplasty using the S-ROM modular system with metal-on-metal articulation or ceramic-on-ceramic articulation had favorable clinical and radiological mid- to long-term results.

Keyword

Femoral head; Osteonecrosis; Primary THRA; Cementless modular femoral stem

MeSH Terms

Arthroplasty
Dislocations
Follow-Up Studies
Head
Hip
Humans
Osteolysis
Osteonecrosis
Postoperative Complications
Survival Rate

Figure

• 

  Fig. 1 A 41-year-old man underwent total hip arthroplasty due to osteonecrosis of the femoral head using a S-ROM stem with ceramic on ceramic articulation. (A) Anteroposterior radiograph obtained at postoperative 2-years shows no remodeling changes. (B) Anteroposterior radiograph obtained at postoperative 6-years shows spot weld in Gruen zone IV.

• 

  Fig. 2 A 43-year-old woman underwent total hip arthroplasty due to osteonecrosis of the femoral head using a S-ROM stem with autogenous superolateral acetabular bone graft. (A) Anteroposterior radiograph obtained at postoperative 2-years shows no remodeling changes. (B) Anteroposterior radiograph obtained at postoperative 9-years shows migration of acetabular cup.

• 

  Fig. 3 Kaplan-Meier probability of survival for the revision was 88.3% (95% confidence interval, 90.5%~84.6%) at follow-up of 122 months when revision for any reason is the end point (black dot line) and 95.7% (95% confidence interval, 97.2%~93.4%) when aseptic loosening of implant is the end point (black line).

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