Total hip arthroplasty in the treatment of osteonecrosis of the femoral head: then and now

Lavernia, Carlos J.; Villa, Jesus M.

doi:10.1007/s12178-015-9290-y

Cited by 19 publications

(14 citation statements)

References 25 publications

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“…[19][20][21] Similarly, others have reported improved results and lower rate of rTHA required for ON. 20,22,23 The present study found no significant differences in rTHA rates between the OA and ON groups, except for 1 year when ON had a small but significantly higher rTHA rate; however, because of the small number of patients who had revision THA within 30 days of their primary surgery, we question whether this was clinically relevant.…”

Section: Discussioncontrasting

confidence: 66%

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

et al. 2017

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Atraumatic osteonecrosis (ON) of the hip is a debilitating disease. Multiple surgical treatment options are available ranging from joint-preserving procedures to total hip arthroplasty (THA), which is the most commonly performed treatment not only for ON but also for osteoarthritis (OA). Multiple studies have described the rates and trends of THA for OA and ON; however, none have directly compared the two. Therefore, the purpose of this study was to (1) determine the frequency and trends of joint replacement procedures; (2) compare these findings between the ON and OA populations; and (3) assess trends for revision total hip arthroplasty (rTHA). The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was evaluated for this study. All patients in this database obtained between 2008 and 2014 who had a diagnosis of hip ON or OA were identified using International Classification of Disease, 9th revision codes for hip ON and OA. This yielded 68,434 patients, including 3,816 patients with ON (mean age: 55 years, range: 18?90 years) and 64,618 patients with OA (mean age: 65 years, range: 18?90). The Cochran-Armitage test for trends was used to assess the differences in THA and rTHA rates over the study time period for each cohort. To compare whether these rates were different between ON and OA patients, we performed a Z-test between the groups for each year. The annual number of primary THA performed increased for both ON and OA between 2008 and 2014 (from 62 to 989 and from 1,011 to 19,004, respectively). The rate of primary THA significantly increased from 69 to 88% in ON patients. The rate of THAs for ON, out of all THAs performed for both ON and OA, decreased from 5.8% in 2008 to 4.9% in 2014. . The rate of rTHAs performed for both ON and OA decreased during this time (1.1?0.4% for ON and 0.4?0.2% for OA). ON patients had a significantly higher rate of rTHA only in 2011 and a higher rate of overall revisions. The rate of THA is increasing for both ON and OA, but the slope of the increase is higher for ON. This may indicate that orthopaedic surgeons are more confident in performing THA as newer devices and designs are being developed, allowing for better survivorship and outcomes. Additionally, although the overall rate of revision was higher in the ON cohort, at most annual time points, there was no significant difference. Further research is needed to determine why such trends exist.

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Section: Discussioncontrasting

confidence: 66%

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

et al. 2017

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“…A systematic literature review, showed a significant decrease in revision rates in patients who had surgery in 1990 or later, versus those who underwent surgery before 1990, with revision surgery performed or indicated in 17% (0–50%) and 3% (range 0–7%) of hips respectively [26]. This trend was confirmed in recent reviews that showed survivorship higher than 90% and remarkable improvements in clinical outcomes of contemporary cementless THAs performed for ONFH, due to major advances in the production techniques of implants, in bearing coupling and improved polyethylene sterilization and storage [27, 28]. …”

Section: Introductionmentioning

confidence: 94%

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

Capone

Bienati

Torchia

et al. 2017

BMC Musculoskelet Disord

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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.

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“…stage V-VI of Pennsylvania system or stage IV of Ficat classification) in patients who have intractable pain. The indications for hip arthroplasty are: failure of femoral head procedures, femoral head collapse or joint degenerative changes (13,14), considering patient-specific factors (age, symptoms, prognostic factors). The operative procedures designed to save the femoral head don't prevent the progression of disease in hips that have already collapsed and they are associated with high failure rates (15).…”

Section: Femoral Head Replacement Proceduresmentioning

confidence: 99%

“…Surgeon has to think further than the first implant. In literature there is no evidence of superiority of: specific implant design, use of particular bearing surface combination or cementation rather than cementless implant (14,23,25) (Figure 3). Initially, several studies showed poor results of THA in osteonecrosis treatment with a high failure rate (2,26,27).…”

Section: Femoral Head Replacement Proceduresmentioning

confidence: 99%

Hip replacement in femoral head osteonecrosis: current concepts

Scaglione

Fabbri

Celli

et al. 2015

ccmbm

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SummaryOsteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient's factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems.

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Total hip arthroplasty in the treatment of osteonecrosis of the femoral head: then and now

Cited by 19 publications

References 25 publications

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

Total Hip Arthroplasty Procedure Frequencies in Patients with Osteonecrosis versus Osteoarthritis

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

Hip replacement in femoral head osteonecrosis: current concepts

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