J Korean Orthop Assoc.  2010 Aug;45(4):273-280.

Bipolar Hip Arthroplasty vs. Total Hip Arthroplasty for Osteonecrosis of the Femoral Head

Affiliations
  • 1Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea. campbellkim@naver.com

Abstract

PURPOSE
To retrospectively compare surgical outcomes between bipolar hip arthroplasty and total hip arthroplasty in patients with osteonecrosis of the femoral head. MATERIALS AND
METHODS
Between April 2000 and July 2004, we reviewed 51 cases with Ficat stage III osteonecrosis of the femoral head that underwent bipolar hip arthroplasty (BHA) and 52 cases that received total hip arthroplasty (THA). The minimum follow-up period was 5 years. All prostheses used in the current study had cementless stem and metal-on-polyethylene bearings. We analyzed clinical and radiological results, reoperation, operation time and blood loss the BHA group (mean follow-up of 81 months) and the THA group (82 months).
RESULTS
There were no statistically differences between the two groups in preoperative and postoperative mean Harris hip scores. There were no significant differences between the two groups in clinical results, including persistent inguinal pain and radiologic changes around the acetabular cup and femoral stem (p>0.05). Three cases (5.9%) in the BHA group and 5 cases (7.7%) in the THA group underwent revisions. The mean operation time was 96 minutes in the BHA group and 118 minutes in the THA group. Mean blood loss was 625 cc in the BHA group, and 784 cc in the THA group. The differences between the two groups in mean operation time and blood loss were significant (p<0.05).
CONCLUSION
The BHA group, which used cementless stem and metal-on-polyethylene bearings for Ficat stage III osteonecrosis of the femoral head, showed no significant differences from the THA group in postoperative radiologic change, clinical evaluation, and reoperation during 81 months of mean follow-up.

Keyword

osteonecrosis; femoral head; bipolar hip arthroplasty; total hip arthroplasty

MeSH Terms

Arthroplasty
Butylated Hydroxyanisole
Follow-Up Studies
Head
Hip
Humans
Osteonecrosis
Prostheses and Implants
Reoperation
Retrospective Studies
Tacrine
Ursidae
Butylated Hydroxyanisole
Tacrine

Figure

  • Figure 1 Radiographs of a 54-year-old man treated with bipolar hip arthroplasty in one hip and total hip arthroplasty in the other. (A, B) The patient was suffering from osteonecrosis of the right femoral head with flattening (Ficat Stage III) and osteonecrosis of the left femoral head with a preserved spericity (Ficat Stage IIA). (C) Postoperative radiograph after receiving total hip arthroplasty in the right hip. (D) In the left side, femoral head flattening was found at the 1.5-year follow-up. (E) Postoperative radiograph after receiving bipolar hip arthroplasty in the left hip. (F) No acetabular cup migration or femoral stem loosening was seen on the radiograph at 6 years after bipolar hip arthroplasty. The patient still had a satisfactory result in the both sides at the last follow-up.

  • Figure 2 Radiographs of a 76-year-old woman treated with bipolar hip arthroplasty in right hip. (A) Preoperative radiograph shows asuperomedial migration of head. (B, C) Preoperative T1 weighted (B) & T2 weighted (C) MRI shows subchondral collapse without flattening. (D) Postoperative radiograph after receiving bipolar hip arthroplasty in the right hip. (E) A migration of outer head was found at the 3-year follow-up. (F) A migration of outer head and sclerotic change of acetabulum were progressed at the 5.4-year follow-up.


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