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The Journal of Bone and Joint Surgery 80:1656-64 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Surface Replacement Hemiarthroplasty for the Treatment of Osteonecrosis of the Femoral Head*

MARC W. HUNGERFORD, M.D.{dagger}, MICHAEL A. MONT, M.D.{dagger}, BALTIMORE, RICHARD SCOTT, M.D.{ddagger}, CHRISTOPHER FIORE, M.D.{ddagger}, BOSTON, MASSACHUSETTS, DAVID S. HUNGERFORD, M.D.{dagger} and KENNETH A. KRACKOW, M.D.§, BALTIMORE, MARYLAND

Investigation performed at the Division of Arthritis Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, and Brigham and Women's Hospital and Harvard Medical School, Boston

We reviewed the results of thirty-three femoral resurfacing procedures in twenty-five patients who had stage-III or early stage-IV osteonecrosis of the femoral head according to the classification system of Ficat and Arlet. There were no perioperative complications. Thirty hip prostheses (91 percent) survived for a minimum of five years. At a mean of 10.5 years (range, four to fourteen years) postoperatively, sixteen (62 percent) of the twenty-six hips with stage-III disease had a good or excellent Harris hip score. Four of the seven hips with stage-IV disease did not have or need a total hip arthroplasty. Overall, twenty hips (61 percent) had a good or excellent result according to the scoring system of Harris, and thirteen (39 percent) had a fair or poor result and subsequently had or needed a total hip arthroplasty. The mean interval between the hemiarthroplasty and the total hip arthroplasty was sixty months (range, thirty-six to 136 months). These thirteen hips all had a successful clinical result (a Harris hip score of at least 80 points) at a mean of thirty months (range, twenty-four to seventy-two months) after the total hip arthroplasty. The results of the present study suggest that resurfacing of the femoral head can be a successful interim procedure for the management of patients who have Ficat and Arlet stage-III or early stage-IV disease with a large lesion that is not amenable to other treatment options except total hip arthroplasty.


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