DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20175108

Treatment of osteonecrosis of femoral head in young patients by surface replacement of femoral head

Mahendra Kumar Reddy Mundla, Someswara Reddy Buchupalli, Srikar Reddy G., Krishna Reddy S

Abstract


Background: Osteonecrosis of hip is a pathological condition that affects usually young adults. Articular surface replacement (ASR) is considered to be a viable option in young patients. The study was done with the aim to analyse and to recommend the management of osteonecrosis of femoral head in young patients by surface replacement of femoral head as ideal procedure.

Methods: The present study was conducted in 30 patients with osteonecrosis of the femoral head who attended to OPD at Santhiram Medical College and General Hospital, Nandyal, A.P during the period of April 2016 to September 2017. Articular surface replacement of the femoral head was the surgical procedure done in all the patients. The success of the treatment was analysed by Harris hip scoring.

Results: Maximum number of patients (60%) was below 40 years of age. Male dominance (77%) was seen in the study. According to Ficat and Arlet classification 12 cases (40%) were under the category of stage II-B and 18 cases (60%) were of stage III. Postoperatively about 90% of patients had postoperative Harris hip score of >80 points. Surgery was succeeded in 10 hips of stage II-B and 15 hips in stage III. According to Harris hip scoring excellent results were obtained in 15 (50%), good in 12 (40%), fair in 2 (6.67%) and poor result 1 (3.3%) patient.

Conclusion: The study concludes that the surface replacement is an anatomical hip arthroplasty with preservations of more than 70% of bone stock of femoral head and the ability of the patients to sit cross-legged and squat, which is the desire of the Indian population.


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References


Lavernia CJ, Sierra RJ, Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop Surg 1999;7(4):250-61.

Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). New England J Med. 1992;326:1473-9.

Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg. 1995;77(3):459-74.

Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg. 1995;77(1):42-9.

Dean MT, Cabanela ME. Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Longterm results. J Bone Joint Surg. 1993;75(4):597-601.

Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg. 1995;77:681-94.

Scher MA, Jakim I. Intertrochanteric osteotomy and autogenous bone-grafting for avascular necrosis of the femoral head. J Bone Joint Surg. 1993;75:1119-33.

Amstutz HC, Grigoris P, Safran MR, Grecula MJ, Campbell PA, Schmalzried TP. Precision-fit surface hemiarthroplasty for femoral head osteonecrosis. Long-term results. J Bone Joint Surg. 1994;76(3):423-27.

Meulemeester FR, Rosing PM. Uncemented surface replacement for osteonecrosis of the femoral head. Acta Orthop Scandinavica. 1989;60:425-9.

Tooke SM, Amstutz HC, Delaunay C. Hemiresurfacing for femoral head osteonecrosis. J Arthroplasty. 1987;2:125-33.

Cornell CN, Salvati EA, Pellicci PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North America. 1985;16:757-69.

Fyda TM, Callaghan JJ, Olejniczak JP, Johnson RC. Minimum ten-year follow-up of cemented total hip replacement in patients with osteonecrosis of the femoral head. Orthop Trans. 1997;21:62-3.

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. 1989;244:198-207.

Rubash HE, Sinha RK, Shanbhag AS, Kim SY. Pathogenesis of bone loss after total hip arthroplasty. Orthop Clin North Am. 1998;29:173-86.

Ficat RP, Arlet J. Functional investigation of bone under normal conditions. In: DS Hungerford, editor. Ischemia and Necrosis of Bone. Baltimore: Williams and Wilkins; 1980: 29-52.

Harris WH. Traumatic Arthritis of the Hip after Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty: An End-Result Study Using A New Method Of Result Evaluation. J Bone Joint Surg Am. 1969;51:737-55.

Scaglione M, Fabbri L, Celli F, Casella F, Guido G. Hip replacement in femoral head osteonecrosis: current concepts. Clin Cases Miner Bone Metab. 2015;12(1):51-4.

Hungerford MW, Mont MA, Scott R, Fiore C, Hungerford DS, Krackow KA. Surface replace¬ment hemiarthroplasty for the treatment of os¬teonecrosis of the femoral head. J Bone Joint Surg Am. 1998;80:1656-64.

Koo KH, Kim R. Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Joint Surg Br. 1995;77(6):875–80.

Jameson SS, Langton DJ, Nargol AVF. Articular Surface Replacement of the hip: a prospective single-surgeon series. J Bone Joint Surg Br. 2010;92:28-37.

Krackow KA, Mont MA, Maar DC. Limited femoral endoprosthesis for avascular necro¬sis of the femoral head. Orthop Rev. 1993;22:457-63.

Amstutz HC, Grigoris P, Safran MR, Grecula MJ, Campbell PA, Schmalzried TP. Precision-fit surface hemiarthroplasty for femoral head osteonecrosis. Long-term results. J Bone Joint Surg. 1994;76(3):423-7.

Meulemeester FR, Rosing PM. Uncemented surface replacement for osteonecrosis of the femoral head. Acta Orthop Scandinavica. 1989;60:425-9.

Sedel L, Travers V, Witvoet I. Spherocylindric (Luck) cup arthroplasty for osteonecrosis of the hip. Clin Orthop. 1987;219:127-35.