Functional outcome of non-cemented total hip arthroplasty for avascular necrosis in adults of below 50 years age group

Pathik Biswas; Jahangir Alam; Jobayer Al Mahmud; Shariful Alam; Humayun Kabir; Ananya Shankhary Brishti

doi:10.18203/issn.2455-4510.IntJResOrthop20263892

Authors

Pathik Biswas Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Jahangir Alam Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Jobayer Al Mahmud Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Shariful Alam Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Humayun Kabir Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
Ananya Shankhary Brishti Dhaka Medical College Hospital, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263892

Keywords:

Young adults, Total hip arthroplasty, Osseointegration, Non-cemented prosthesis, Avascular necrosis, Functional outcome, Harris hip score, Hip replacement

Abstract

Background: Avascular necrosis (AVN) of the femoral head is a progressive disorder causing joint destruction and functional impairment, particularly in younger adults. Total hip arthroplasty (THA) is the standard treatment for advanced AVN and non-cemented prostheses are increasingly preferred because of their biomechanical advantages and long-term stability. This study evaluated the functional outcomes of non-cemented THA in AVN patients under 50 years of age.

Methods: A prospective observational study was conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to March 2024. Thirty-four patients with late-stage AVN (Ficat & Arlet Stage III and IV) underwent non-cemented THA. Functional outcomes were assessed preoperatively and postoperatively using the Harris Hip Score (HHS), range of motion (ROM), pain severity, walking distance and need for support. Data were analyzed using SPSS version 25, with p<0.05 considered statistically significant.

Results: The mean age was 35.50±7.01 years and 73.53% were male. Mean HHS improved significantly from 37.12 preoperatively to 91.44 postoperatively (p=0.001), with 61.8% achieving excellent outcomes (HHS >90). Significant improvements were observed in pain severity, limping, support dependency and walking distance (p=0.001). ROM also improved significantly, with 64.71% achieving a postoperative ROM of 161°–210°. Complications were minimal, including superficial surgical site infection in 5.88% and limb length discrepancy in 2.94%.

Conclusions: Non-cemented THA provides significant pain relief and improvement in mobility, ROM and functional outcomes in AVN patients under 50 years, with minimal complications, supporting its use in younger active patients.

References

Piston RW, Engh CA, De Carvalho PI, Suthers K. Osteonecrosis of the femoral head treated with total hip arthroplasty without cement. JBJS. 1994;76(2):202.

Mahajan P, Subramanian S, Jadhav A, Danke A, Parab S. Etiopathogenesis and Stem Cell Treatment Outcomes in Avascular Necrosis of the Femoral Head: A Review of 50 Cases. BJMMR. 2017;20(12):1–9.

Tsai HL, Chang JW, Lu JH, Liu CS. Epidemiology and risk factors associated with avascular necrosis in patients with autoimmune diseases: a nationwide study. Korean J Intern Med. 2022;37(4):864–76.

Matthews AH, Davis DD, Fish MJ, Stitson D. Avascular Necrosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2025.

Goncharov EN, Koval OA, Nikolaevich Bezuglov E, Aleksandrovich Vetoshkin A, Gavriilovich Goncharov N, Encarnación Ramirez MDJ, et al. Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review. Med Sci. 2024;12(3):32.

Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, et al. Avascular Necrosis of Femoral Head—Overview and Current State of the Art. International Journal of Environmental Research and Public Health. 2022;19(12):7348.

Scully SP, Aaron RK, Urbaniak JR. Survival Analysis of Hips Treated with Core Decompression or Vascularized Fibular Grafting Because of Avascular Necrosis. JBJS. 1998;80(9):1270.

Hassan DF, Majeed GH, Al-Sudani AF. Non Traumatic Hip Osteonecrosis Treated By Non Vascularised Bone Graft Versus Core Decompression. AL-Kindy Coll Med J. 2016;12(2):49–55.

Bakshi AS, Singh M, Kaur G, Singh J, Kaur H. A Retrospective Observational Study to Compare the Outcome of Various Treatment Modalities of Idiopathic Avascular Necrosis of Hip. Int J Appl Basic Med Res. 2022;12(4):265.

Nath R, Gupta AK, Chakravarty U, Nath R. Primary cemented total hip arthroplasty: 10 years follow-up. IJOO. 2025;44(3):283–8.

Grelsamer R. The results of improved cementing techniques for total hip arthroplasty in patients less than fifty years old. A ten-year follow-up study. JBJS. 1995;77(5):808.

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.

Inoue H, Kosuga T, Kubota T, Konishi H, Shiozaki A, Okamoto K, et al. Significance of a preoperative systemic immune-inflammation index as a predictor of postoperative survival outcomes in gastric cancer. World J Surg Oncol. 2024;19(1):173.

Meftah M, Ranawat AS, Ranawat CS. Duribility of a non-cemented, hemispherical, rim-fit, hydroxyapatite coated acetabular component. Orthopaed Proceed. 2025;98(9):41–1.

Dorai JB, Shreemal BB, Shankar A, Oommen AT, Jeyakkani MN. Avascular necrosis of femoral head – Demographic profile, natural history of asymptomatic hips and native hip survivorship in an indian subcontinent cohort. J Clin Orthopaed Trauma. 2024;59:102801.

Patil D. A prospective study to evaluate the clinical and functional outcome of uncemented total hip replacement in avascular necrosis of femoral head in adults. Nat J Clin Orthop. 2019;3(2):10–6.

Katz RL, Bourne RB, Rorabeck CH, Mcgee H. Total hip arthroplasty in patients with avascular necrosis of the hip: follow-up observations on cementless and cemented operations. Clin Orthopaed Rel Res. 1992;281:145.

Ulucay C, Ozler T, Guven M, Akman B, Kocadal AO, Altintas F. Etiology of coxarthrosis in patients with total hip replacement. Acta Orthopaedica et Traumatologica Turcica. 2013;47(5):330–3.

Chokotho L, Harrison WJ, Lubega N, Mkandawire NC. Avascular necrosis of the femoral head in HIV positive patients-an assessment of risk factors and early response to surgical treatment. Malawi Med J. 2013;25(2):28–32.

Kim YH, Oh JH, Oh SH. Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 1995;(320):73–84.

Garino JP, Steinberg ME. Total Hip Arthroplasty in Patients with Avascular Necrosis of the Femoral Head; A 2− to 10-Year Followup. Clinical Orthopaedics and Related Research. 1997;334:108.

Abbas-Zadeh MR, Azizi A, Abbas-Zadeh L, Amirian F. Effect of surgical treatment on the quality of life in patients with non-traumatic avascular necrosis of the femoral head. Rev Bras Ortop. 2018;53(6):773–7.

Lins RE, Barnes BC, Callaghan JJ, Mair SD, Mccollum DE. Evaluation of uncemented total hip arthroplasty in patients with avascular necrosis of the femoral head. Clin Orthopaed Related Res. 2025;297:168.

Pakhan AA, Phansopkar P, Boob MA. Rehabilitation to Complement Unique Single-Stage Core Decompression and Total Hip Arthroplasty in Bilateral Avascular Necrosis: A Case Report. Cureus. 2025;16(1):52914.

Saklecha AV, Wadhokar OC, Patil DS, Naqvi WM. Effect of physiotherapy rehabilitation on stage 4 avascular necrosis of femur following pyogenic arthritis: a case report. Pan Afr Med J. 2022;41:17.

Lee SH, Lee GW, Seol YJ, Park KS, Yoon TR. Comparison of Outcomes of Total Hip Arthroplasty between Patients with Ankylosing Spondylitis and Avascular Necrosis of the Femoral Head. Clin Orthoped Surg. 2025;9(3):263–9.