Results of Total Hip Arthroplasty after Core Decompression with Tantalum Rod for Osteonecrosis of the Femoral Head

Abstract

Background Early stage osteonecrosis of the femoral head (ONFH) has many treatment options including core decompression with implantation of a tantalum rod. The purpose of this study was to evaluate clinical and radiological outcomes and potential complications during conversion total hip arthroplasty (THA) in such patients. Methods Six male patients (8 hips) underwent THA subsequent to removing a tantalum rod (group I) from April 2010 to November 2011. We retrospectively reviewed the medical records of these patients. We enrolled 12 age- and sex-matched patients (16 hips) during the same period, who had undergone primary THA without a previous operation as the control group (group II). All patients were followed for at least 3 years. We checked the Harris hip score (HHS), operative time, and volume of blood loss. Radiological results, including inclination, anteversion of the acetabular cup, presence of periprosthetic osteolysis, and subsidence of femoral stem were checked at the last follow-up. Results The mean preoperative HHS values were 56.5 (range, 50 to 62) and 59.1 (range, 42 to 70) in groups I and II, respectively. The HHS improved to 96.0 (range, 93 to 100) and 97.6 (range, 93 to 100), respectively, at the 3-year follow-up ( p = 0.172). Mean operation time was 98.8 minutes (range, 70 to 120 minutes) in group I and 77.5 minutes (range, 60 to 115 minutes) in group II ( p = 0.006). Total blood loss volumes were 1,193.8 mL (range, 960 to 1,360 mL) and 944.1 mL (range, 640 to 1,280 mL) in groups I and II, respectively ( p = 0.004). No significant differences in inclination or anteversion of acetabular cup and no evidence of osteolysis or subsidence of the femoral stem were reported in either group in radiological follow-up results. However, one case of squeaking occurred in group I during the follow-up. Conclusions The two groups showed no clinical or radiological differences except extended operative time and increased blood loss. However, the incidence of squeaking (1 of 8 hips) was higher, as compared to the control group or previously reported values.

Platelet‑rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors

“…In recent years, an increasing number of patients are being diagnosed with osteoarthritis, which has a notable impact on human health and quality of life (2,3). The causes of osteoarthritis are complex, and the pathogenesis related to this disease is not well understood (4).…”

Comparison of Total Hip Arthroplasty after Two Types of Failed Hip Preserving Procedures with Primary Total Hip Arthroplasty

“…There are numerous clinical reports about its efficacy, but few reports of total hip arthroplasty after failed PTI surgery. Lee et al . compared six patients (eight hips) who underwent total hip arthroplasty after failed PTI surgery with 12 patients (16 hips) who underwent primary total hip arthroplasty.…”

“…Conversion to a total hip arthroplasty after failed hip joint preserving procedure is considered a technically challenging procedure in respect of removing the implant, which may result in increased blood loss, bone loss, extended operative time and potential risk of trochanteric fracture. Lee et al 9 stated that the total surgery duration and blood loss volume in patients who underwent total hip arthroplasty after failed PTI were significantly higher than those in the primary total hip arthroplasty group. Olsen et al 10 stated that there was no significant difference in postoperative and radiological follow-up results between total hip arthroplasty after failed PTI and primary total hip arthroplasty group, but the surgery duration and intraoperative blood loss volume were not compared.…”

Total hip arthroplasty following failure of tantalum rod implantation for osteonecrosis of the femoral head with 5- to 10-year follow-up

“…Although core decompression for Steinberg stage I and Steinberg stage II disease was successful as a definitive procedure in > 80% and 60% of patients, respectively, approximately 30–71% of treatments fails and converts to THA [11, 18]. The conversion to THA is technically demanding in terms of removing the metallic rod, increased blood loss, prolonged operative time, bone loss and the potential risk of femoral fracture [19, 20]. Olsen et al [6] compared the clinical outcome of 21 patients (21 hips), who received THA following a failed index procedure for tantalum rod implantation, with a cohort of 21 patients (21 hips), who received primary THA for the same diagnosis.…”