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Primary total hip replacement in Ficat-Arlet stage 3 and 4 osteonecrosis: a retrospective study at a minimum 12-year
Roger Erivan1,2, Thomas Caputo3, Hicham Riouach3
1CNRS, SIGMA Clermont, ICCF, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France. rerivan@chu-clermontferrand.fr.
Insights
Total hip replacement (THR) for aseptic osteonecrosis shows good implant survival rates. Rigorous follow-up is crucial for early complication detection in patients with hip osteonecrosis.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Clinical outcomes research
Background:
- Aseptic osteonecrosis of the hip presents controversial treatment outcomes with different implant types.
- This study retrospectively evaluated implant survival in primary total hip replacement (THR) for aseptic osteonecrosis.
- The hypothesis posited equivalent THR outcomes for aseptic osteonecrosis and osteoarthritis.
Purpose of the Study:
- To assess implant survival rates in primary total hip replacement (THR) for aseptic osteonecrosis.
- To evaluate complications and clinical score progression following THR in this patient cohort.
- To determine the efficacy of THR for advanced stages of hip osteonecrosis.
Main Methods:
- A single-center retrospective study involving 54 patients undergoing metal-on-metal THR for femoral head osteonecrosis.
- Primary endpoint: revision surgery for any cause (implant or procedure-related).
- Secondary endpoints: complication rates and changes in clinical scores (Harris and PMA).
Main Results:
- Mean follow-up was 13.9 years; 33.3% of patients died during the study period.
- Implant survival at last follow-up was 93.8%.
- A total of 12 complications (22.2%) were recorded, with significant improvements in Harris (43.1 points) and PMA (5.6 points) scores.
Conclusions:
- Primary THR demonstrated good implant survival for aseptic osteonecrosis.
- Vigilant follow-up is essential to monitor for potential complications.
- THR is a justified treatment option for Ficat-Arlet stage 3 and 4 aseptic osteonecrosis of the hip.
Introduction:
Results of total hip replacement (THR) for aseptic osteonecrosis are controversial and conflicting according to implant type and generation. The present study consisted in a retrospective assessment of implant survival in primary THR for aseptic osteonecrosis, using a cemented stem, standard polyethylene press-fit acetabular component, and metal-metal bearing. The study hypothesis was that THR results are equivalent between aseptic osteonecrosis and osteoarthritis of the hip.
Material And Method:
A single-center retrospective study included 54 patients with metal-on-metal THR for femoral head osteonecrosis. The main endpoint was revision surgery for all causes, whether implant related or procedure related; secondary endpoints were complications and progression in clinical scores.
Results:
Mean follow-up was 13.9 ± 1.6 years (range 12.0-17.1 years). Eighteen of the 54 patients (33.3%) died. Implant survival at last follow-up was 93.8% (95% CI, 87.1-100). There were 12 complications (22.2%): 1 intraoperative, 5 (9.3%) immediate postoperative, and 6 (11.1%) long term. Clinical assessment found a significant 43.1 point improvement in mean Harris score (p = 8.4E-33) and a 5.6 point improvement in mean PMA score (p = 2.9E-22).
Conclusion:
Survival in primary THR for aseptic osteonecrosis was good. Follow-up needs to be rigorous to screen for onset of complications. Primary THR is thus justified in Ficat-Arlet stage 3 and 4 aseptic osteonecrosis of the hip.
Level Of Evidence:
IV.
