The Journal of Bone and Joint Surgery 82:1408 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Osteonecrosis of the Femoral Head Treated with Cementless Total Hip Arthroplasty*
William T. Hartley, M.D. ,
James P. McAuley, M.D.,
William J. Culpepper, M.S.,
C. Anderson Engh, Jr., M.D. and
Charles A. Engh, Sr., M.D.
Investigation performed at the Anderson Orthopaedic Research
Institute, Alexandria, Virginia
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Anderson Orthopaedic Research Institute, P.O. Box 7088, Alexandria,
Virginia 22307.
Background: The treatment of young patients
who have osteonecrosis of the femoral head associated with collapse
or substantial secondary degeneration remains a therapeutic challenge,
with total hip arthroplasty being a treatment of choice. However, concerns
about the durability of the results of hip arthroplasty in this
population necessitate long-term evaluation of this treatment option.
To determine its advantages and limitations, we evaluated the results
of cementless total hip arthroplasty in a consecutive series of
young patients with advanced osteonecrosis.
Methods: We reviewed the results of fifty-five
consecutive primary total hip arthroplasties, after an average of 117
months of follow-up, in forty-five patients with a preoperative
diagnosis of advanced osteonecrosis of the femoral head (Ficat and
Arlet stage III or IV). The average age was thirty-one years (range,
twenty-one to forty years) at the time of the operation. We collected
data prospectively with the use of patient questionnaires and radiographs.
Results: Five patients died and one patient
was lost to follow-up before the time of the minimum five-year follow-up;
this left forty-eight hips in thirty-nine patients for inclusion
in the study. Ten (21 percent) of the forty-eight hips required
revision. No revisions were due to aseptic failure of the femoral component.
Of the remaining twenty-nine patients (thirty-eight hips), twenty-seven
(93 percent) reported few or no functional limitations and twenty-three
(79 percent) could walk an unlimited distance at the time of the
latest follow-up. Pain was absent or mild in twenty-five patients
(86 percent). Twenty-three patients (79 percent) were employed full-time.
Radiographically, thirty-seven femoral components (97 percent) were
bone-ingrown and the remaining component was judged to be fibrous
stable. All thirty-eight acetabular components were bone-ingrown.
Conclusions: Cementless total hip arthroplasty
remains a reasonable treatment option for advanced osteonecrosis
of the femoral head. Wear of the bearing surface continues to limit
the long-term success rate, but we are encouraged by the predictable long-term
stability of the bone-implant interface achieved with cementless
fixation. These results compare favorably with those of published
reports of total hip arthroplasty with cement in younger patients
with osteonecrosis.
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