DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20211603

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

Mohmad Nawaz Rather, Wajahat Ahmad Mir, Shahid Shabir Khan, Naseer Ahmad Mir, Nadeem Ali

Abstract


Background: Osteonecrosis of femoral head (ONFH) is characterised by cell death in the subchondral bone caused by abnormalities of blood flow to the femoral head. About 5% to 13% of arthroplasties are performed yearly for ONFH in United States. Ficat and Arlet classification is the commonest system used for grading of ONFH. Advanced stages 3 and 4 are best managed with total hip arthroplasty (THA). THA restores hip range of movement and allows early ambulation in ONFH.

Methods: After seeking approval from local institutional ethical committee 25 patients with stage 3 and stage 4 ONFH (Ficat and Arlet) were admitted from OPD of SKIMS MC and Hospital Bemina, Srinagar. The study was conducted from February 2018 to February 2020 in department of Orthopaedics SKIMS MC and Hospital Bemina, Srinagar.  25 patients with mean age of 50.64 years comprising of 13 females and 12 males with unilateral osteonecrosis of femoral head with collapsed head underwent uncemented total hip arthroplasty and were followed up to a minimum of 1 year post-operatively.

Results: Outcome was evaluated by comparing pre-operative and post-operative Harris hip scores. The average Harris hip scores improved from 65.87 in the pre-operative group to 96.54 at 1-year follow-up post-operatively. Marked improvement was noted in pain scores. No revisions were performed during the study. One patient developed superficial surgical site infection which healed with supervised dressings and oral antibiotics.

Conclusions: Uncemented THA has excellent short-term outcomes in advanced stages of ONFH. It provides mobile hip joint and pain free ambulation shortly after surgery.


Keywords


Osteonecrosis of femoral head, Total hip arthroplasty, Harris hip score

Full Text:

PDF

References


Chandler FA. Coronary disease of the hip. J Int Coll Surg. 1948;11(1):34-6.

Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med. 1992;326(22):1473-9.

Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77(1):34-41.

Ficat RP. Treatment of bone ischemia and necrosis. In: Hungerford DS, eds. Ischemia and necrosis of bone. Baltimore: Williams & Wilkins; 1980: 171.

Mont MA. Corrective osteotomy for osteonecrosis of femoral head:the results of long term follow-up. J Bone Joint Surg. 1996;78:1032-8.

Pyda M, Koczy B, Widuchowski W, Widuchowska M, Stołtny T, Mielnik M, et al. Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head. Med Sci Monit. 2015;21:304-9.

Saito S, Saito M, Nishina T, Ohzono K, Ono K. Long-term results of total hip arthroplasty for osteonecrosis of the femoral head. A comparison with osteoarthritis. Clin Orthop Relat Res. 1989;(244):198-207.

Kim YH, Kim JS, Park JW, Joo JH. Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report. J Bone Joint Surg Am. 2011;93(19):1806-10.

Andersson L, Wesslau A, Bodén H, Dalén N. Immediate or late weight bearing after uncemented total hip arthroplasty: a study of functional recovery. J Arthroplasty. 2001;16(8):1063-5.

Ancelin D, Reina N, Cavaignac E, Delclaux S, Chiron P. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res. 2016;102(8):1029-34.

Shah N, Singh AK, Sharma A, Pawar E, Nadwi ST Shet V. Preoperative assessment and postoperative outcome of total hip replacement in adults with AVN. Int J Orthop Sci. 2017;3(3):986-91.

Reddy MRS, Shivakumar MS, Phadet P. Study of clinical and functional outcome of total hip replacement in avascular necrosis of femoral head International J Orthop Sci 2018;4(1):252-8.

Ortiguera CJ, Pulliam IT, Cabanela ME. Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term follow-up. J Arthroplasty. 1999;14(1):21-8.

Rahangdale A, Raza HKT, Maravi LS, Sirsikar A. A prospective study of early complications of uncemented total hip arthroplasty for avascular necrosis of femoral head.

El ESS, Megahed RM. Cementless total hip arthroplasty in post-traumatic avascular necrosis of the femoral head in young adults Egypt Orthop J. 2013;48:282–8.

Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60(2):217-20.

Hirakawa K, Mitsugi N, Koshino T, Saito T, Hirasawa Y, Kubo T. Effect of acetabular cup position and orientation in cemented total hip arthroplasty. Clin Orthop Relat Res. 2001;(388):135-42.

Brinker MR, Rosenberg AG, Kull L, Galante JO. Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head. J Arthroplasty. 1994;9(5):457-68.

Mont MA, Seyler TM, Plate JF, Delanois RE, Parvizi J. Uncemented total hip arthroplasty in young adults with osteonecrosis of the femoral head: a comparative study. J Bone Joint Surg Am. 2006;88 (3):104-9.

Sivakanthan A, Sharath KR, Kohli R. Uncemented total hip replacement using hydroxyapatite coated stem in vascular necrosis of femur head. Internat J Sci Res. 2016;5(5):880-2.