Short stem total hip arthroplasty for osteonecrosis of the femoral head in patients 60 years or younger: a 3- to 10-year follow-up study

Abstract

BackgroundIn young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary. However, only a few studies have evaluated the outcome of short-stem THAs in ONFH. We reviewed the prospectively collected data of a cementless partial neck-retaining short-stem with ceramic-on-ceramic bearings in ONFH patients.MethodsThirty patients (37 hips) younger than 60 years (mean age at surgery, 51.5 years) underwent THA with the NANOS® stem (Smith and Nephew, Marl, Germany) from January 2006 to December 2012. All patients received a 32-mm or 36 mm ceramic femoral head. Harris hip score, WOMAC and UCLA activity score were recorded. Postoperative radiographs were evaluated for bone-implant fixation and osteolysis. Further analysis correlated clinical findings with implants characteristics and patient demographics at mean 5.6 years’ follow-up (range, 3–10 years).ResultsThe clinical and functional results improved significantly (p < 0.001). At latest follow-up, mean HHS, WOMAC, and UCLA activity scores were 90 (range, 71–100), 94 (range, 76–100), and 6.3 (range, 4–10) points, respectively. The diameter of the femoral head did not influence the clinical outcome (p = 0.661). All hips showed bone ingrowth fixation of the acetabular and femoral components. No patients showed osteolysis. No revision for any reason was performed during the study period.ConclusionsThe excellent clinical results and fixation pattern at mean 5.6 years’ follow-up reveal this implant as a reliable option in advanced stage of ONFH either. Further investigations are crucial to determine the long-term durability and to assess whether the association of ceramic-on-ceramic bearings, can be useful to achieve longer survivorship and lower complications rates.Trial registrationRegistry number: ISRCTN 91336248; date of registration: 04/07/2017.

Uncemented short stems in primary total hip arthroplasty

“…The Nanos stem demonstrated a survivorship of 100% with stem revision for any reason as the endpoint, at a mean follow-up of 4.4 years (2.3 to 5.6) in 193 hips. 68 – 70 The mean HHS at the final follow-up assessment was 93.6 points (90 to 97 points) in 193 hips. 68 – 70 In two studies including 109 hips, 69 , 70 the authors investigated the incidence of thigh pain reporting two cases (1.8%) of slight non-disabling pain, and the coronal stem malalignment reporting valgus and varus position in 1.8% of the hips, respectively.…”

Stromal-Cell-Derived Factor (SDF) 1-Alpha Overexpression Promotes Bone Regeneration by Osteogenesis and Angiogenesis in Osteonecrosis of the Femoral Head

“…Although corticosteroid usage [5], alcohol consumption [6, 7], and trauma [8] have been identified as risk factors for ONFH, its pathogenesis remains poorly understood. Currently, surgical prevention is the conventional therapeutic strategy, which is invasive and may decrease the quality of life.…”

The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

“…According to several studies cortical strut allografts represent a reliably solution in the treatment of periprosthetic femoral fractures (PFF) in patients with a hip arthroplasty [26][27][28]. Particularly, grafts have been applied in periprosthetic femoral fractures, classified as type B1 (fracture around a stable femoral stem) of the Unified Classification System (UCS), in type C (fracture below the stem) and in re-osteosynthesis of a previously failed fixation, with union rates ranging from 92% to 100% [26,[29][30][31][32][33][34][35][36]. In a systematic review reporting the outcome of B1 fractures, no significant difference in healing rates between plate fixation alone and plate fixation with strut graft were found (91% vs. 92%, p < 0.05).…”