J Korean Hip Soc.  2010 Jun;22(2):129-136. 10.5371/jkhs.2010.22.2.129.

Cementless Total Hip Arthroplasty for Osteonecrosis of the Femoral Head: A Follow-up Study for 10+ Years

• Chung JW
• Park SW
• Han SB
• Park JH
• Kim HJ
• Lee WS

• KMID: 1461134
• DOI: http://doi.org/10.5371/jkhs.2010.22.2.129

Abstract

PURPOSE
The aim of this study was to assess the outcome of cementless total hip arthroplasty (THA) in cases of osteonecrosis of the femoral head.
MATERIALS AND METHODS
We studied long-term outcomes for 54 patients (72 hips). Mean duration of follow-up was 13.5 years. Clinical outcomes were evaluated by the Harris Hip Score. Radiographic evaluation from the preoperative and follow-up periods included assessment of the fixation of the femoral and acetabular components, polyethylene wear, osteolysis, and radiolucent line.
RESULTS
The mean Harris Hip Score improved from a preoperative value of 51.9 points to 89.4 at final follow-up. Regarding the femoral components, there was radiographic evidence of stable bony ingrowth in 69 hips, stable fibrous ingrowth in 2 hips and unstable fixation in 1 hip. There was a radiolucent line of less than 1 mm in 7 hips, and femoral osteolysis in 27 hips. Regarding the acetabular components, there was radiographic evidence of stable fixation in 68 hips, unstable fixation in 4 hips, and osteolysis in 39 hips. There was a significant correlation between (i) failure of components and (ii) femoral osteolysis, acetabular osteolysis, polyethylene thickness, linear wear rate per year, or total linear wear.
CONCLUSION
The findings of this study show favorable long term results, both clinical and radiographic, using cementless total hip replacement arthroplasties. However, the revision rates for the Harris-Galante acetabular components were high. Wear of the load? weight? bearing surface continues to limit the long-term success rate of THA, and improved design of the acetabular components should be considered.

Keyword

Femoral head; Osteonecrosis; Cementless femoral stem; Cementless acetabular cup; Primary THRA

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip
Follow-Up Studies
Head
Hip
Humans
Osteolysis
Osteonecrosis
Polyethylene
Tacrine
Ursidae
Polyethylene
Tacrine

Figure

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  Fig. 1 (A) Preoperative anteroposterior radiograph of a 45-year old male shows Ficat stage IV osteonecrosis of both femoral heads. (B) Radiograph was taken 2 weeks (left) and 6 weeks (right) after total hip arthroplasty using Harris-Galante type 2 acetabular cup and circumferential porous coated Multilock femoral stem. (C) Radiograph taken 16 years after the index operation shows stable fixation of the acetabular cup and bone ingrowth fixation of the femoral stem.

• 

  Fig. 2 (A) Preoperative anteroposterior radiograph of a 44-year old male shows Ficat stage IV osteonecrosis of both femoral heads. (B) Radiograph was taken 4 weeks (right) and immediately (left) after total hip arthroplasty using Harris-Galante type 2 acetabular cup and non-circumferential porous coated Harris-Galante type 1 femoral stem. (C) Radiograph taken 14 years after the index operation shows subsidence with osteolysis of right femoral stem in Gruen zone 1, 2, 3, 5 ,6, 7, and extensive osteolysis in Charnley zone 1, 2, 3 with locking mechanism failure (arrow head) and polyethylene wear of right acetabular cup.

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  Fig. 3 (A) Preoperative anteroposterior radiograph of a 39-year old male shows Ficat stage IV osteonecrosis of both femoral heads. (B) Radiograph was taken 12 weeks (right) and 2 weeks (left) after total hip arthroplasty using Harris-Galante type 2 acetabular cup and Multilock femoral stem for both sides. (C) Radiograph taken 16 years after the operation shows extensive osteolysis of right acetabular cup in Charnley zone 2, 3 with locking mechanism failure (arrow head), but stable fixation with bone ingrowth of right femoral stem. In contrast, it shows stable fixation of left femoral stem and acetabular cup.

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