Resection arthroplasty in radiation-induced osteonecrosis of the hip

The purpose of this study was to evaluate the choice of appropriate surgical procedure through follow-up of postoperative results in patients with radiation-induced osteonecrosis of the hip.

From January 1990 to December 2010, 25 patients underwent surgery for hip osteonecrosis after pelvic irradiation, for a total of 31 cases. The mean patient age was 61.6 years and the mean follow-up period was 60.4 months. There were 28 cases of primary total hip arthroplasty, three cases of primary resection arthroplasty, and six cases of secondary resection arthroplasty after total hip arthroplasty failure. The THA group was classified into two groups according to the period of operation: 1990 ∼ 2000 and 2001 ∼ 2010. THA and resection arthroplasty were compared retrospectively.

In the 16 cases of primary total hip arthroplasty (1990 ∼ 2000), 8 cases (50%) had a failed acetabular component. In 12 cases of primary total hip arthroplasty (2001 ∼ 2010), two cases (16.7%) had a failed acetabular component and two cases (16.7%) had an infection. Six cases underwent resection arthroplasty after total hip arthroplasty. There were no complications in the nine cases of resection arthroplasty. Seven of the nine cases (77.7%) had pain relief. The mean VAS scores of the resection arthroplasty group were lower than those of the total hip arthroplasty group at the time of the latest follow up (P = 0.04).

The failure rate of total hip arthroplasty used in radiation necrosis has decreased. Therefore, total hip arthroplasty should be the primary surgical method in patients with radiation-induced osteonecrosis of the hip. Resection arthroplasty is limited as first-line therapy due to functional problems. It use should be limited to pain control in low-demand elderly patients.