Short Term Clinical Outcome of a Porous Tantalum Implant for the Treatment of Advanced Osteonecrosis of the Femoral Head

Abstract

Purpose of the study: Osteonecrosis of the hip mostly affects young individuals and oftenprogresses to a debilitating disease. Several treatment modalities exist, but none are completely satisfactory. This study evaluates the clinical outcome of patients treated with core decompression and insertion of a porous tantalum implant in the femoral head. This procedure is similar to commonly performed procedures, but has the additional advantages of providing structural support to the necrotic femoral head while having no donor-site morbidity. Methods: We evaluated 15 patients with 18 osteonecrotic hips with Steinberg stage III (3 hips) and IV (15 hips) disease. The mean age of the patients was 42 years-old (eldest 66), and the mean time for follow-up was 23 months. The outcome measure was hip function, evaluated with the Harris hip score, and the end point was total hip arthroplasty, or referral for this procedure. Results: The success rate at twelve months postoperatively was 77.8%, and the overall success rate was 44.5%. Failures occurred at a mean time of 11.7 months, and one complication, a periprosthetic fracture, occurred 4 months postoperatively. On average, patients who did well improved their Harris hip scores by 21.7 points, and patients who eventually required arthroplasty decreased their scores by 14 points. Conlusions: Core decompression with porous tantalum implants showed encouraging success rates and early clinical results in patients with advanced stage osteonecrosis, but further larger scale studies are required to identify the population best suited for this procedure.

Outcome after a new porous tantalum rod implantation for treatment of early-stage femoral head osteonecrosis

“…This method was first proposed by Brown et al in 1993 (6) who indicated that a porous tantalum rod was a reasonable mechanical substitute for a fibular graft. In a multicenter study, Tsao et (22). Although there was no statistical difference between Runze and Zimmer implants in our study, the survival rate was significantly higher than that reported in Tsao et al (5), Liu et al (20), and Nadeau et al (22), and similar to that of Pakos et al (19).…”

“…In a multicenter study, Tsao et (22). Although there was no statistical difference between Runze and Zimmer implants in our study, the survival rate was significantly higher than that reported in Tsao et al (5), Liu et al (20), and Nadeau et al (22), and similar to that of Pakos et al (19). Thus, Runze tantalum implants, with a 95% survival, appear to be a feasible option.…”

Porous tantalum implant for treatment of early-stage osteonecrosis of the femoral head: a minimum 5-year follow-up study

“…However, the long-stage effect of porous tantalum rod implantation is uncertain. Porous tantalum rod implantation in the treatment of femoral head necrosis failed and convert to THA has been successively reported [ 18 , 19 ].…”

“…ONFH is a progressive disease that easily affects young patients with age about 35 years [ 24 ].The young patients have a good prognosis after hip conserving surgery. The follow-up results of Nadeau et al [ 18 ] showed that the mean age at surgery of the patients who failed was (50.1 ± 12.1) years old, compared to a mean age of (36.8 ± 12.2) years old for the patients whose tantalum implant did not fail, with significant difference ( P < 0.05). Age is one of the prognostic factors of porous tantalum rod implantation.…”

Biomechanics of Additively Manufactured Metallic Scaffolds—A Review

“…Long, et al [99] and Meneghini, et al [100] implanted porous TA seal cones into patients with total knee arthroplasty and found them to have stable bone ingrowth and good osseo-integration. Nadeau, M. et al [101] reported overall 44.5% success rate when porous TA plugs were implanted into 15 patients with advanced stage of osteonecrotic hips. Tsao, et al [102] conducted a similar study where porous TA plugs were implanted into 98 patients with early-stage osteonecrotic hips and found that the average Harris hip score increased from 63 preoperatively to 83 after 4 years.…”