The Journal of Bone and Joint Surgery (American) 85:675-681 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Contemporary Total Hip Arthroplasty with and without Cement in Patients with Osteonecrosis of the Femoral Head
Young-Hoo Kim, MD,
S.-H. Oh, MD,
J.-S. Kim, MD and
K.-H. Koo, MD
Investigation performed at The Joint Replacement Center of Korea, Seoul, Korea
Young-Hoo Kim, MD
S.-H. Oh, MD
J.-S. Kim, MD
The Joint Replacement Center of Korea, 627-3, JaYang 1-Dong, KwangJin-Gu, Seoul 143-190, Korea. E-mail address for Y.-H. Kim: younghookim{at}netsgo.com
K.-H. Koo, MD
Department of Orthopaedic Surgery, KyungSang University College of Medicine, Jinju, Korea
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Presented in part as a poster exhibit at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Dallas, Texas, February 13-17, 2002.
Background: The rate of failure of primary total hip arthroplasty in patients with osteonecrosis of the femoral head is higher than that in patients with osteoarthritis. The purpose of this prospective study was to document the clinical and radiographic results of arthroplasty with so-called third-generation cementing and the results of second-generation cementless total hip arthroplasty in ninety-eight consecutive patients with osteonecrosis of the femoral head.
Methods: Fifty patients who had had simultaneous bilateral total hip arthroplasty with a cemented stem in one hip and a cementless stem in the other and forty-eight patients who had had a unilateral total hip arthroplasty with a cementless stem were included in the study. A cementless acetabular component was used in all hips. The presumed cause of the osteonecrosis was ethanol abuse in fifty-seven patients, unknown in twenty-seven, fracture of the femoral neck in nine, and steroid use in five. There were eighty men and eighteen women. The mean age at the time of the arthroplasty was 47.3 years (range, twenty-six to fifty-eight years). Clinical and radiographic evaluations were performed preoperatively; at six weeks; at three, six, and twelve months; and yearly thereafter. The average duration of follow-up was 9.3 years.
Results: The average Harris hip scores in the group treated with unilateral arthroplasty (97 points) and the group treated with bilateral arthroplasty (94 points) were similar at the time of final follow-up. They were also similar between the group treated with cement (mean, 96 points) and that treated without cement (95 points). No component had aseptic loosening in either group. In one hip, a cemented femoral stem (2%) and a cementless cup were revised because of infection. Two cementless stems (2%) were revised because of fracture of the proximal part of the femur with loosening of the stem. Annual wear of the polyethylene liner averaged 0.22 mm in the group treated with cement (a zirconia head) and 0.14 mm in the group treated without cement (a cobalt-chromium head). The prevalence of osteolysis in zones 1 and 7 of the femur was 16% in the group treated with cement and 24% in the group treated without cement.
Conclusions: Advancements in surgical technique and better designs have greatly improved the long-term survival of cemented and cementless implants in young patients with osteonecrosis of the femoral head. Although there was no aseptic loosening of the components, a high rate of linear wear of the polyethylene liner and a high rate of osteolysis in these high-risk young patients remain challenging problems.
Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.
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