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Total hip arthroplasty in patients with osteonecrosis. The effect of cement techniques
M A Ritter1, J Helphinstine, E M Keating
1Center for Hip and Knee Surgery, Mooresville, IN, USA.
Insights
Total hip replacement is a viable treatment for osteonecrosis caused by alcoholism, hypersteroidism, or idiopathic factors. However, failure rates, particularly femoral component loosening, may be higher in osteonecrosis patients compared to osteoarthritis patients.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Osteonecrosis, a condition leading to bone death, can necessitate total hip replacement (THR).
- Understanding failure rates of THR in osteonecrosis patients is crucial for long-term joint health.
- Causes of osteonecrosis include alcoholism, hypersteroidism, and idiopathic factors.
Purpose of the Study:
- To compare short and long-term total hip arthroplasty (THR) failure rates in patients with osteonecrosis versus osteoarthritis.
- To identify differences in failure modes, including component loosening and revision rates, among various osteonecrosis etiologies.
Main Methods:
- Retrospective analysis of 115 patients undergoing THR for osteonecrosis (alcoholism, hypersteroidism, idiopathic) and 202 for osteoarthritis.
- Statistical comparison of acetabular and femoral component loosening, revision arthroplasty rates, radiolucency, and pain scores.
- Survival analysis to evaluate long-term implant survival.
Main Results:
- Significant differences in femoral component loosening and overall revision/loosening rates were observed among the four groups.
- Survival analysis revealed a significant difference only between the idiopathic osteonecrosis and osteoarthritis groups.
- Second-generation cement technique was a significant factor related to failure.
Conclusions:
- Total hip arthroplasty is an equally viable treatment for the three examined types of osteonecrosis.
- Failure rates, especially femoral component loosening, may be higher in osteonecrosis patients compared to osteoarthritis patients.
- Further research with larger cohorts is needed to fully elucidate long-term outcomes.
Abstract:
One hundred fifteen patients who underwent total hip replacement for osteonecrosis between June 1972 and April 1990 were divided into 3 groups according to the cause of the disorder: (1) osteonecrosis secondary to alcoholism (21 patients), (2) osteonecrosis secondary to hypersteroidism (29 patients), and (3) idiopathic osteonecrosis (65 patients). To determine the differences in short and long term arthroplasty failure rates, these 3 patient groups were compared with a group of 202 patients who received total hip replacement for osteoarthritis. Statistical analyses were carried out on the following definitions of failure: loosening of the acetabular component, loosening of the femoral component, and revision arthroplasty. Radiolucency and postoperative pain scores also were evaluated. A significant difference in the rate of failure because of loosening of the femoral component was found among the 4 groups. Likewise, a significant difference was found among the 4 groups in all revisions or loosenings or both. However, only the comparison between the idiopathic osteonecrosis and osteoarthritic groups showed a significant difference with survival analysis. Second generation cement technique was as significant as any variable relating to failure. The authors conclude that total hip arthroplasty is an equally viable treatment for the 3 types of osteonecrosis examined in this study; however, failure might be more imminent in studies where larger numbers are needed.