Journal List > J Korean Hip Soc > v.23(3) > 1048725

Kim, Park, Cho, and Kim: The Results of Cementless Total Hip Arthroplasty for Primary Osteoarthritis Compared with Avascular Necrosis of the Femoral Head

Abstract

Purpose

Cementless total hip arthroplasty was performed to treat primary osteoarthritis of the hip and avascular necrosis of the femoral head. The clinical and radiological results of the acetabular cups and femoral stems were compared.

Materials and Methods

The subjects were 84 cases who underwent primary cementless total hip arthroplasty from March 1992 to May 2001. The 84 cases were followed up for at least eight years. The patients were divided into the following two groups: group (A), 38 cases of degenerative osteoarthritis of the hip; and group (B), 46 cases of avascular necrosis of the hip. The clinical evaluation was conducted based on the Harris Hip Score (HHS). A radiological assessment was performed to determine if osteolysis or acetabular loosening had occurred. The results were analyzed statistically.

Results

The postoperative HHS of groups A and B at the final follow-up were 92.1 and 91.2, respectively (p=0.483). The radiological results revealed 9 and 15 cases of acetabular osteolysis (p=0.671) and 1 and 3 cases of vertical migration of the acetabular cups in the group A and B, respectively. Eight and 7 complications (p=0.572) were encountered in group A and B, respectively. Among these, 4 and 5 cases of revisional total hip arthroplasty were performed in group A and B, respectively. The results of survival analysis were similar in the two groups (p=0.969).

Conclusion

The clinical and radiological features of the acetabular cups and stems were similar in the two groups. Nevertheless, further studies will be needed due to the high rate of polyethylene liner wear and osteolysis around the acetabular cups or femoral stems.

Figures and Tables

Fig. 1
(A) Radiographs of 67-old-year woman with primary osteoarthritis of the hip joint. Note that the joint space narrowing of hip and marginal bony spurs. (B) An immediate postoperative radiograph shows good position and alignment of the cup and stem. (C) 9 years later postoperatively, Patient was free of pain and achieved full ROM in the hip joint and shows stable fixation of cup without osteolysis.
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Fig. 2
(A) Radiographs of 65-year-old-man with avascular necrosis of the femoral head secondary to chronic alcoholism. Note that the necrotic lesion occupies almost the entire femoral head. (B) An immediate postoperative radiograph shows good position and alignment of the cup and stem. (C) After 10 years later cementless total hip arthroplasty, he was free of pain and achieved full ROM in the hip joint and shows stable fixation of cup without osteolysis.
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Fig. 3
Kaplan-Meier estimate of survival of total hip prosthesis in months from the index surgery using revision for any reason as the end point.
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Table 1
Patient Demographic and Clinical Data by Group
jkhs-23-192-i001

SPSS statistical package (SPSS 17.0 Chicago, Illinois), Studenet T-test, Paired T-test

*p-value of <0.05 were considered the level of statistical significance difference.

Table 2
Radiologic Results (Acetabular Cup)
jkhs-23-192-i002

SPSS statistical package (SPSS 17.0 Chicago, Illinois), chi-square test, ANOVA

*p-value of <0.05 were considered the level of statistical significance difference.

Table 3
Radiologic Results (Femoral Stem)
jkhs-23-192-i003

SPSS statistical package (SPSS 17.0 Chicago, Illinois), chi-square test

*p-value of <0.05 were considered the level of statistical significance difference.

Table 4
Complications
jkhs-23-192-i004

SPSS statistical package (SPSS 17.0 Chicago, Illinois), chi-square test

*p-value of <0.05 were considered the level of statistical significance difference.

References

1. 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.
crossref
2. Cornell CN, Salvati EA, Pellicci PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North Am. 1985. 16:757–769.
crossref
3. Xenakis TA, Beris AE, Malizos KK, Koukoubis T, Gelalis J, Soucacos PN. Total hip arthroplasty for avascular necrosis and degenerative osteoarthritis of the hip. Clin Orthop Relat Res. 1997. 341:62–68.
crossref
4. 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. 51:737–755.
crossref
5. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976. 121:20–32.
crossref
6. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990. 72:518–528.
crossref
7. Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration. An experimental study. J Arthroplasty. 1989. 4:245–251.
8. Gruen TA, Mcneice GM, Amstutz HC. "Modes of failure" of cemented stem type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979. 141:17–27.
9. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br. 1987. 69:45–55.
crossref
10. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958. 53:457–481.
crossref
11. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973. 55:1629–1632.
12. Burkart BC, Bourne RB, Rorabeck CH, Kirk PG. Thigh pain in cementless total hip arthroplasty. A comparison of two systems at 2 years' follow up. Orthop Clin North Am. 1993. 24:645–653.
13. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990. 257:107–128.
14. Ranawat CS, Atkinson RE, Salvati EA, Wilson PD Jr. Conventional total hip arthroplasty for degenerative joint disease in patients between the ages of forty and sixty years. J Bone Joint Surg Am. 1984. 66:745–752.
crossref
15. Cornell CN, Salvati EA, Pellici PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North Am. 1985. 16:757–769.
crossref
16. Salvati EA, Cornell CN. Long-term follow-up of total hip replacement in patients with avascular necrosis. Instr Course Lect. 1988. 37:67–73.
17. 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.
18. Ritter MA, Meding JB. A comparison of osteonecrosis and osteoarthritis patients following total hip arthroplasty.A long-term follow-up study. Clin Orthop Relat Res. 1986. 206:139–146.
19. Piston RW, Engh CA, De Carvalho PI, Suthers K. Osteonecrosis of the femoral head treated with total hip arthroplasty without cement. J Bone Joint Surg Am. 1994. 76:202–214.
crossref
20. Park SW, Baek JR, Lee SW, Lee DH. Osteolysis around cementless acetabular component. J Korean Hip Soc. 2004. 16:423–427.
21. 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:Suppl 3. 104–109.
crossref
22. Kim YH, Park KC, Jang JH, Choi IY. A comparison of total hip arthroplasty between osteonecrosis and osteoarthritis of the hip-retrospective matched pair study-minimum 5 years of follow up. J Korean Hip Soc. 2000. 12:1–8.
23. Chiang PP, Burke DW, Freiberg AA, Rubash HE. Osteolysis of the pelvis: evaluation and treatment. Clin Orthop Relat Res. 2003. 417:164–174.
24. Friedman RJ, Black J, Galante JO, Jacobs JJ, Skinner HB. Current concepts in orthopaedic biomaterials and implant fixation. Instr Course Lect. 1994. 43:233–255.
crossref
25. Shon WY, Hur CY, Moon JG, Whang JH. Pelvic osteolysis on hybrid THA: 5-11.5 years follow-up study. J Korean Hip Soc. 2004. 16:324–331.
26. Claus AM, Sychterz CJ, Hopper RH Jr, Engh CA. Pattern of osteolysis around two different cementless metal-backed cups: retrospective, radiographic analysis at minimum 10-year follow-up. J Arthroplasty. 2001. 16:Suppl 1. 177–182.
crossref
27. Stulberg SD, Wixon RL, Adams AD, Hendrix RW, Bernfield JB. Monitoring pelvic osteolysis following total hip replacement surgery:an algorithm for surveillance. J Bone Joint Surg Am. 2002. 84-A:Suppl 2. 116–122.
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