Hip Pelvis.  2014 Jun;26(2):65-73. 10.5371/hp.2014.26.2.65.

Arthroplasty in Femoral Head Osteonecrosis

• Cho YJ
• Nam DC
• Jung K

• KMID: 2054166
• DOI: http://doi.org/10.5371/hp.2014.26.2.65

Abstract

Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head.

Keyword

Hip joint; Osteonecrosis of the femoral head; Arthroplasty

MeSH Terms

Arthroplasty*
Arthroplasty, Replacement, Hip
Friction
Head*
Hemiarthroplasty
Hip
Hip Joint
Humans
Hypersensitivity
Joint Diseases
Osteonecrosis*

Figure

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  Fig. 1 Twenty nine-year-old man with osteonecrosis of the left femoral head underwent hemiresurfacing arthroplasty and anteroposterior radiograph of postoperative 37 months shows good results.

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  Fig. 2 (A) Preoperative anteroposterior (AP) radiograph shows osteonecrosis of left femoral head. (B) Postoperative AP radiograph shows that unipolar arthroplasty has been performed. (C) AP radiograph of postoperative 8 years shows marked prutrosio acetabuli. (D) Conversion total hip arthroplasty was performed.

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  Fig. 3 (A) Anteroposterior (AP) radiograph of postoperative 7-year of bipolar endoprosthesis shows severe acetabular erosion atboth hips. (B) Revision total hip replacement was performed at both hips. (C) AP radiograph of postoperative 12-year shows very satisfactory results.

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  Fig. 4 (A) Preoperative anteroposterior (AP) radiograph shows osteonecrosis of both femoral head, and the patient had history of long term steroid use. (B) Preoperative magnetic resonance imaging scan confirmed the diagnosis. (C) Ceramic on ceramic total hip arthroplasty has been perfomed, and AP radiograph of postoperative 12 years shows very satisfactory results.

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  Fig. 5 Jump distance, the comparison of distance required to move femoral head from bottom to outside of socket between big ball and small ball.

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  Fig. 6 (A) Preoperative anteroposterior (AP) radiograph shows osteonecrosis of both femoral head. (B) Preoperative magnetic resonance imaging scan confirmed the diagnosis and necrotic area was located at anterosuperior aspect both femoral head mainly and extent of the necrotic area was 45% on the right and 40% on the left. (C) Total hip resurfacing arthoplasty was performed using Birmingham hip resurfacing system and AP radiograph of postoperative 6-year shows very satisfactory results without any evidence of stress shielding, osteolysis.

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