Total hip arthroplasty for osteonecrosis: Matched-pair analysis of 188 hips with long-term follow-up

doi:10.1016/S0883-5403(99)90197-3

The Journal of Arthroplasty

Volume 14, Issue 1, January 1999, Pages 21-28

https://doi.org/10.1016/S0883-5403(99)90197-3 Get rights and content

Abstract

A matched comparison was made between total hip arthroplasties done for osteonecrosis and those done for osteoarthritis. Patients were matched for age, sex, surgical approach, prosthesis, and surgeon. All received cemented Charnley replacements and had minimal follow-up of 10 years. There were 118 women and 70 men with a mean age of 58 years. Thirty-five patients were younger than 50. The mean follow-up was 17.8 years (range, 10 to 25.4 years). Revision rates for osteonecrosis and osteoarthritis were 18% and 19% (not significant). The mechanical failure rate (revision for loosening plus radiographic loosening) was greater, but not significantly so, in the osteonecrosis group. In patients younger than 50 years, the revision rate in osteonecrosis (50%) was significantly higher than that in any other group. Similarly, the mechanical failure rate in osteonecrosis was significantly greater in the patients younger than 50. Radiographic femoral loosening was greater in osteonecrosis at all follow-up intervals, and dislocations occurred more frequently in the osteonecrosis group than in the osteoarthritis group. Results of arthroplasty in both groups were comparable in patients over 50 years of age, although patients with osteonecrosis had an increased rate of dislocation. Patients with osteonecrosis who are younger than 50 years have a significantly higher rate of mechanical failure than those with osteoarthritis who are younger than 50 years. Cemented total hip arthroplasty should be recommended in this group with caution if at all.

References (21)

CN Cornell et al.
Long-term follow-up of total hip replacement in patients with osteonecrosis
Orthop Clin North Am
(1985)
LD Dorr et al.
Long-term results of cemented total hip arthroplasty in patients 45 years old or younger: A 16-year follow-up study
J Arthroplasty
(1994)
MR Brinker et al.
Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head
J Arthroplasty
(1994)
HP Chandler et al.
Total hip replacement in patients younger than thirty years old: A five-year follow-up study
J Bone Joint Surg Am
(1981)
LD Dorr et al.
Total hip arthroplasties in patients less than forty-five years old
J Bone Joint Surg Am
(1983)
S Saito et al.
Long-term results of total hip arthroplasty for osteonecrosis of the femoral head: A comparison with osteoarthritis
Clin Orthop
(1989)
A Sarmiento et al.
Total hip arthroplasty with cement: A long-term radiographic analysis in patients who are older than fifty and younger than fifty years
J Bone Joint Surg Am
(1990)
RN Stauffer
Ten-year follow-up study of total hip replacement
J Bone Joint Surg Am
(1982)
LD Dorr et al.
Total hip arthroplasties in patients younger than 45 years: A nine- to ten-year follow-up study
Clin Orthop
(1990)
MA Ritter et al.
A comparison of osteonecrosis and osteoarthritis patients following total hip arthroplasty: A long-term follow-up study
Clin Orthop
(1986)

There are more references available in the full text version of this article.

Cited by (181)

Radiological factors associated with posterior dislocation after total hip arthroplasty for osteonecrosis of the femoral head – A retrospective study
2024, Journal of Orthopaedics
The dislocation rate after total hip arthroplasty for osteonecrosis of the femoral head is higher than that after total hip arthroplasty for osteoarthritis. However, few reports have investigated the factors contributing to dislocation after total hip arthroplasty for osteonecrosis of the femoral head. The aim of this study was to assess radiological factors associated with posterior dislocation after total hip arthroplasty for osteonecrosis of the femoral head.
We retrospectively reviewed 179 cementless total hip arthroplasties for osteonecrosis of the femoral head using a posterolateral approach between 2002 and 2020 with a minimum follow-up period of 24 months. The following radiological factors were examined for a possible association with posterior dislocation after total hip arthroplasty: cup anteversion angle, cup inclination angle, femoral offset, and stem anteversion angle.
Posterior dislocation occurred in seven hips (3.9 %). Compared to hips without posterior dislocation, those with posterior dislocation exhibited a significantly smaller cup anteversion angle (p = 0.045) and a nonsignificantly greater decrease in femoral offset (p = 0.089). Based on receiver operating characteristic curve analyses, the cutoff values for predicting posterior dislocation were 9.9° for the cup anteversion angle and 8.1 mm for the decrease in femoral offset. Logistic regression analysis showed a significantly higher risk of posterior dislocation among hips with a cup anteversion angle less than 9.9° (odds ratio = 7.1, p = 0.022) or with a decrease in femoral offset over 8.1 mm (odds ratio = 5.0, p = 0.040).
A small cup anteversion angle and a decreased femoral offset are suggested to be associated with posterior dislocation after total hip arthroplasty in patients with osteonecrosis of the femoral head.
Total Hip Arthroplasty via direct anterior approach for osteonecrosis; comparison with primary hip osteoarthritis in a mid term follow up
2022, Journal of Clinical Orthopaedics and Trauma
To determine the mid-term outcomes of conventional cementless Total Hip Arthroplasty (THA) in patients with avascular necrosis (AVN) of the femoral head and compare to patients with primary hip osteoarthritis (OA).
A total of 330 consecutive primary THA procedures (AVN and OA) performed between 2010 and 2013 by a single surgeon and in a single center using the direct anterior approach (DAA) were included. Assessments including SF-36, WOMAC, and Harris Hip Scores (HHS) were retrieved from patients before the surgery and at the latest follow-up. Clinical and functional outcomes were compared between the AVN and OA groups.
A total of 294 consecutive THA (AVN = 107, OA = 187) with 104.4 ± 6.2 months follow-up were analyzed, which AVN patients were significantly younger (32.0 vs. 59.6 y/o). Corticosteroid 34 (31.8%), idiopathic AVN 31 (29.0%) and use of unapproved weight gain supplements (UWGS) 23 (21.5%) were the main reasons for AVN. Despite that preoperative scores were comparable (P > 0.05), the HHS, SF-36, and WOMAC scores are significantly higher in the AVN group after THA surgery (P < 0.05). Moreover, flexion and abduction ROM were significantly higher in the AVN group (P < 0.05). Regarding each complication, no significant difference was observed between groups. In the whole sample, there were 5 (1.7%) revisions due to loosening of acetabular components, all the OA group (P > 0.05).
Conventional cementless THA with highly cross-linked polyethylene provides satisfactory mid-term results in patients with AVN with a low rate of postoperative complications. Compared to primary OA patients, this group reaches superior postoperative scores.
Does an Ultra-Short Anatomic Cementless Femoral Stem Improve Long-Term (Up to 17 Years) Results in Patients Younger Than 30 Years?
2022, Journal of Arthroplasty
The purpose of this long-term (up to 17 years) follow-up study was to determine: (1) clinical results and evidence of clicking or squeaking sounds; (2) radiographic results, including rates of osseointegration, bone remodeling, and osteolysis; (3) rates of complications including thigh pain, periprosthetic fracture, and ceramic fracture; (4) rates of revision; and (5) survival rates of implants in patients younger than 30 years.
We analyzed the results of 240 consecutive primary total hip arthroplasty in 180 patients (118 men and 62 women who had a mean age of 27 years (range, 21 to 30 years)). The mean follow-up was 16 years (range, 14 to 17 years).
Mean Harris hip score, Western Ontario and McMaster Universities score, and University of California, Los Angeles activity score were 93 points, 18 points, and 7 points, respectively, at final follow-up. Radiographically, all of the acetabular components and all but two femoral components were well-fixed at the final follow-up. No hip had osteolysis or exhibited Grade 3 stress shielding. All but two patients had no groin or thigh pain. No hip had a periprosthetic or ceramic fracture. Eight hips (3%) exhibited squeaking sounds. Two acetabular components and two femoral stems were revised. The survival of the acetabular and femoral component was 99.2% (95% confidence interval, 94 to 100%).
The results of the present long-term study of ultra-short anatomic cementless femoral stems suggest excellent clinical and radiographic results in patients younger than 30 years.
An early experience of the use of dual mobility cup uncemented total hip arhroplasty in young patients with avascular necrosis of the femoral head
2022, Journal of Clinical Orthopaedics and Trauma
THA (Total hip arthroplasty) in advanced grade (grade 4) avascular necrosis (AVN) is a challenge to the treating surgeon as it affects young patients who have high functional demands and increased dislocation risk. The aim of the study was to evaluate the efficacy, survivorship, and dislocation rate of uncemented dual mobility cups (DMC) in advanced grade IV AVN young patients.
Retrospective cohort study involving 204 DMC THA for advanced grade IV AVN from January 2013 to December 2015. The sample size of the study was estimated to be 188 hips with an α error of 0.05 and β error of 0.2. Inclusion criterion was patients less than 55 years of age with advanced grade IV AVN. Patients >55 years of age, patients diagnosed with primary osteoarthritis of the hip and hip fracture were excluded from the study. 172 patients (32 with bilateral & 140 with unilateral affection) with 204 DMC THA were evaluated clinically by Harris Hip Score (HHS) and radiologically at a follow up of 60 months. P value < 0.05 was considered significant.
Mean age of the patients was 42.5 ± 5.3. Preoperative HHS was 50.6 ± 10.5. Postoperative HHS at 5 years follow up was 96.4 ± 2.6. None of the operated patient had any dislocation episode or had undergone hip revision surgery (statistically significant against historical control of 2%, p value = 0.042). The radiological evaluation at 5 years showed no signs of radiolucent lines, periprosthetic osteolysis, polyethylene wear and signs of displacement or migration of the DMC. Cumulative survivorship rate at 5 years follow up was 100% without any revision/dislocation.
Use of DMC THA in young, advanced grade IV AVN patients was found to be a reliable option showing excellent early functional results with no dislocation. Ongoing follow up of this cohort is required to confirm the maintenance of these excellent functional results at follow up in the long term.
Excellent Long-Term Survival Rate of Polished, Tapered, Cemented Stems in Patients Aged 35 Years or Younger With Avascular Necrosis or Inflammatory Arthritis of the Hip
2022, Journal of Arthroplasty
Total hip arthroplasty (THA) for avascular necrosis (AVN) or inflammatory arthritis (IA) comes with a relatively high risk of aseptic stem loosening, especially in young patients. There are limited long-term data on the survivorship of polished, tapered, cemented stems in this population. We therefore performed a single-center retrospective study investigating the survival of this particular stem type in young patients with AVN or IA.
All patients aged ≤35 years who had received a THA for AVN or IA operated on by the senior author between 1990 and 2010 at the University Hospitals Leuven were identified. In total, 85 THAs in 62 patients were included. Primary endpoint was revision of the femoral component for aseptic loosening. Secondary endpoints were revision of the acetabular component for aseptic loosening, revision for other reasons, and the presence of radiolucencies around the components.
The mean follow-up for the entire cohort was 18.0 ± 5.3 years (range 8.0-28.9). Taking revision for aseptic loosening as endpoint, the survival of cemented stems was 100% after 15 years and 95.1% after 20 years. Survival of uncemented cups (91.3%) was significantly better than survival of cemented cups (50.3%) after 20 years of follow-up for aseptic loosening. Taking revision for any reason as endpoint, the survival of THAs with uncemented and cemented cups was 90% and 43.1% at 20 years respectively. Radiolucencies developed in the cement mantles around 11 of the 81 nonrevised stems, mainly in zones 1 and 7.
In this cohort of young patients with high-risk profiles for aseptic stem loosening, polished, tapered, cemented stems showed excellent long-term survival rates and they therefore remain a viable alternative to uncemented stem designs.
Thirty-Day Complications in Osteonecrosis Patients Following Total Hip Arthroplasty
2020, Journal of Arthroplasty
Thirty-day complications in osteonecrosis (ON) patients undergoing total hip arthroplasty (THA) are inconsistently reported. Therefore, the purpose of this study is to evaluate (1) the incidence of THA, (2) operative times, (2) length of stay, (3) reoperation rates, (4) readmission rates, and (5) complication rates, in the general vs ON THA populations. We also substratified and compared these cohorts based on ON-specific risk factors.
Using the National Surgical Quality Improvement Program database, Current Procedural Terminology code 27130, International Classification of Disease, Ninth Edition code 733.42, and a 1:1 propensity score match, a total of 8344 matched ON and non-ON THA patients were identified. ON patients were also substratified based on key risk factors. The above variables were compared between the matched ON and non-ON cohorts as well as for patients with each risk factor using Pearson’s chi-square and Student t-tests.
The proportion of THAs performed on ON patients decreased by 35% from 2008 to 2015. Mean operative times were constant between the ON and non-ON patients (102 minutes). ON patients had shorter mean length of stay (3.1 vs 3.4 days, P = .002). Of the 17 different 30-day complications evaluated, superficial surgical site infection (1.2% vs 0.6%, P = .004), pneumonia (0.8% vs 0.2%, P = .001), transfusion (15.6% vs 5.4%, P < .001), and readmission (5.1% vs 2.3%, P = .012) were higher among ON patients. ON patients with a history of corticosteroid use, higher American Society of Anesthesiologists score, and smoking were also found to have higher complication rates compared to non-ON patients with the same risk factors.
This is one of the first studies to compare postoperative THA outcomes between matched ON vs non-ON patients, while also taking into consideration specific risk factors between the cohorts.

View all citing articles on Scopus

View full text

Original articleTotal hip arthroplasty for osteonecrosis: Matched-pair analysis of 188 hips with long-term follow-up

Abstract

Orthop Clin North Am

J Arthroplasty

J Arthroplasty

Total hip replacement in patients younger than thirty years old: A five-year follow-up study

J Bone Joint Surg Am

Total hip arthroplasties in patients less than forty-five years old

J Bone Joint Surg Am

Long-term results of total hip arthroplasty for osteonecrosis of the femoral head: A comparison with osteoarthritis

Clin Orthop

Total hip arthroplasty with cement: A long-term radiographic analysis in patients who are older than fifty and younger than fifty years

J Bone Joint Surg Am

Ten-year follow-up study of total hip replacement

J Bone Joint Surg Am

Total hip arthroplasties in patients younger than 45 years: A nine- to ten-year follow-up study

Clin Orthop

A comparison of osteonecrosis and osteoarthritis patients following total hip arthroplasty: A long-term follow-up study

Clin Orthop

Original article
Total hip arthroplasty for osteonecrosis: Matched-pair analysis of 188 hips with long-term follow-up