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Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term follow-up
C J Ortiguera1, I T Pulliam, M E Cabanela
1Department of Orthopedics, Mayo Clinic, and Mayo Foundation, Rochester, Minnesota 55905, USA.
Insights
Total hip arthroplasty outcomes for osteonecrosis and osteoarthritis were similar in patients over 50. However, younger patients (<50) with osteonecrosis faced significantly higher revision and mechanical failure rates.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Epidemiology
Background:
- Osteonecrosis and osteoarthritis are leading causes of hip joint failure.
- Total hip arthroplasty (THA) is a common treatment for end-stage hip disease.
- Long-term outcomes of THA in osteonecrosis versus osteoarthritis require further comparative analysis.
Purpose of the Study:
- To compare the long-term outcomes of cemented Charnley total hip arthroplasty in patients with osteonecrosis versus osteoarthritis.
- To identify patient subgroups with differential THA success rates based on etiology.
Main Methods:
- Matched comparison study of 188 patients (118 female, 70 male) undergoing cemented Charnley THA.
- Patients were matched for age, sex, surgical approach, prosthesis, and surgeon.
- Minimum 10-year follow-up (mean 17.8 years) assessing revision rates, mechanical failure, loosening, and dislocations.
Main Results:
- Overall revision rates were comparable (18% osteonecrosis vs. 19% osteoarthritis).
- Patients younger than 50 with osteonecrosis showed significantly higher revision (50%) and mechanical failure rates compared to other groups.
- Increased radiographic femoral loosening and dislocation rates were observed in the osteonecrosis group, particularly in younger patients.
Conclusions:
- Cemented THA provides comparable outcomes for osteonecrosis and osteoarthritis in patients over 50.
- Younger patients (<50) with osteonecrosis experience significantly worse outcomes, including higher mechanical failure rates.
- Caution is advised when considering cemented THA for osteonecrosis in patients under 50.
Abstract:
A matched comparison was made between total hip arthroplasties done for osteonecrosis and those done for osteoarthritis. Patients were matched for age, sex, surgical approach, prosthesis, and surgeon. All received cemented Charnley replacements and had minimal follow-up of 10 years. There were 118 women and 70 men with a mean age of 58 years. Thirty-five patients were younger than 50. The mean follow-up was 17.8 years (range, 10 to 25.4 years). Revision rates for osteonecrosis and osteoarthritis were 18% and 19% (not significant). The mechanical failure rate (revision for loosening plus radiographic loosening) was greater, but not significantly so, in the osteonecrosis group. In patients younger than 50 years, the revision rate in osteonecrosis (50%) was significantly higher than that in any other group. Similarly, the mechanical failure rate in osteonecrosis was significantly greater in the patients younger than 50. Radiographic femoral loosening was greater in osteonecrosis at all follow-up intervals, and dislocations occurred more frequently in the osteonecrosis group than in the osteoarthritis group. Results of arthroplasty in both groups were comparable in patients over 50 years of age, although patients with osteonecrosis had an increased rate of dislocation. Patients with osteonecrosis who are younger than 50 years have a significantly higher rate of mechanical failure than those with osteoarthritis who are younger than 50 years. Cemented total hip arthroplasty should be recommended in this group with caution if at all.