Study of clinical and functional outcome of total hip replacement in avascular necrosis of femoral head

Abstract

Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Since young age is associated with high functional demand AVN may have a devastating effect on the quality of life. The natural course of this disease is one of relentless progression with eventual collapse of the femoral head followed by secondary osteoarthritic changes in the hip. The management depends upon many factors including severity and location of necrotic lesion, patient factors and probability of collapse. Total hip replacement (THR) is needed in cases of collapse of femoral head, severe pain, osteoarthritis or destruction of hip joint. However there has been debate over whether THR is a viable option for AVN considering unique pathophysiology of AVN. Moreover the factors like functional outcome after surgery implant longevity and need for revision surgeries must be considered while doing total hip arthroplasty. In this context we conducted this prospective observational study to find out the clinical and functional outcomes of THR in patients with of AVN. Aims and Objectives: To study the clinical and functional outcome of total hip replacement in avascular necrosis of femoral head. Material and methods: Patients admitted to department of orthopedics in a tertiary care hospital in a metropolitan city with diagnosis of AVN were included in the study after taking into consideration a predefined inclusion and exclusion criteria for the study. Sample size of 30 was considered following statistical formula and admission registry of our hospital. Patients were recruited to the study after approval from institutional ethical committee and informed consent of patients. A detailed history was taken and thorough clinical examination was done in all patients. All patients were assessed with Harris hip score and points were allocated for each components of the score, which formed base line statistics for our study. Further patients were followed up at 6 weeks, 12 weeks and 24 weeks. Patients who could not turn up to the hospital were contacted over telephone and outcome was assessed through set of questionnaire based on Harris hip score. Result: The study consisted of 30 patients diagnosed to be having avascular necrosis of head of femur. Out of these 30 patients 23 were males and 7 patients were females with a M: F ratio of 1: 0.30. The most common age group affected was 21-40 years (43.33%) followed by 41-60 years (33.33%) and 61-80 years (23.33%). Majority of the patients with AVN had a body mass index between 25 to 29.99 (36.67%). Co-morbidities like diabetes or hypertension were seen in 11 (36.67%) patients. 9 (30%) patients were having history of either alcohol consumption or smoking. 13 patients had some predisposing factor for AVN in the form of either alcohol consumption, steroid therapy, history of trauma or pregnancy and rest of the patients were found to be having idiopathic AVN. The most common presenting complaints in the studied cases were found to be pain and difficulty in walking (9...

Outcome analysis of bilateral total hip replacement in patients of avascular necrosis of femoral head

“…Results were similar to the study done by Kakaria et al 9 where all 20 patients had Good to Excellent results. Similarly, in the study done by Reddy et al, 6 all 30 patients had results Good to Excellent.…”

“…In our study, history of steroid intake was present in 17.5% patients. In the study conducted by Reddy et al, 6 6.67% patients had history of steroid use. Wu et al 12 in his study concluded fat hypertrophy, intravascular coagulation & fat emboli as important risk factors of steroid-induced ischemic bone necrosis which may develop during initial 1 year of steroid intake.…”

Short term outcome of primary un-cemented total hip arthroplasty in osteonecrosis of femoral head

“…The grading of outcome in our study was in line with the studies. 12,[18][19][20] In our study there were no dislocations with the posterolateral approach and posterior soft tissue repair. Kim et al reported three dislocations in his study which were attributed to the use of 22 mm head and habitual squatting on floor.…”

“…This is comparable to other studies. 11,12 Our study group comprised of both posttraumatic as well as non-traumatic AVN of femoral head.…”

“…The improvement in HHS was comparable to other studies. 12,14,15,18 The grading of outcome based on the improvement in HHS showed 96% graded as excellent while 4% were graded as good. The grading of outcome in our study was in line with the studies.…”