Total hip arthroplasty for osteonecrosis

The success of Charnley cemented total hip arthroplasty for osteonecrosis of the femoral head was assessed using survival analysis. Eighty-seven total hip arthroplasties were followed up for an average of 5.7 years (range, 1.4-13.0 years). There were 59 women and 28 men. The average age was 60 years (range, 30-84 years). Using Charnley hip scores, all patients showed significant progress. The survival analysis showed that using femoral loosening, revision, and pain scores less than 5 as end points, survival was 0.61, 0.94, and 0.81, respectively. With revision as an end point, there were no differences between patients in groups less than 50 and greater than or equal to 50 years of age, weighing less than 185 and greater than =185 lb, and men versus women. There was an 11.5% overall revision rate. Charnley cemented total hip arthroplasty is a viable alternative for patients with painful osteonecrosis.     

Hip resurfacing and osteonecrosis: results from an independent hip resurfacing register

Introduction

Single surgeon studies from specialized centers have suggested that metal-on-metal hip resurfacing in patients with osteonecrosis of hip joint provides good implant survival and function.

Method

We tested the hypothesis that multicenter results of hip resurfacing, in terms of function and survival, are similar between patients with osteoarthritis and osteonecrosis.

Patients

192 patients (202 hips) underwent metal-on-metal hip resurfacing at different centers around the world. We compared the revision risks in 95 patients (101 hips) with osteonecrosis and 97 patients (101 hips) with osteoarthritis.

Results

The mean age at operation was 42 and 43 years and the preoperative and postoperative Harris hip scores were 62 and 96 and 58 and 95 for osteonecrosis and osteoarthritis groups. Survival with revision for any reason as the end point at last follow-up was 97.7% for osteonecrosis and 95.0% for osteoarthritis.

Conclusion

We conclude that hip resurfacing can be offered to patients with osteonecrosis.     

全髋关节表面置换术治疗股骨头坏死的Meta分析

目的通过综合分析已发表文献,探讨全髋关节表面置换术治疗股骨头坏死的效果及安全性。方法通过系统检索从1990年1月到2011年12月全髋关节表面置换术治疗股骨头坏死的相关文献,按照排除标准筛选后,提取需要的数据,通过循证医学Meta分析方法,加权汇总分析。结果共检出192篇相关文献检出,经过三个阶段的筛选,共有10篇被纳入分析,共有317例患者,376例髋关节,男性患者191例,女性126例,平均加权年龄为41.98岁（16～77岁）,加权平均随访时间36.69个月（6～140个月）。术后的髋关节Harris评分（92分）较术前（44分）的差异有统计学意义（t=18.07,P〈0.01）。主要并发症包括假体无菌性松动（1.06%）、异位骨化（0.80%）、疼痛（0.80%）和股骨颈骨折（0.27%）,最终翻修率为0.80%。结论全髋关节表面置换术治疗股骨头坏死是安全有效的,但需要注意其并发症。     

金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死的短期临床效果

目的探讨新一代的金属对金属髋关节表面置换术治疗重度股骨头无菌性坏死（FicatⅢ、Ⅳ）的短期临床效果。方法对28例（33髋）诊断为股骨头无菌性坏死的患者行金属对金属髋关节表面置换手术。股骨头无菌性坏死程度按照Ficat分期：Ⅲ期24例（27髋），Ⅳ期4例（6髋），手术时的平均年龄是48岁（21-77岁），其中男患者17例（60.7%），女患者11例（39.3%）。术后随访内容包括所有患者的临床及影像学资料。结果平均随访时间为24个月（11-35个月），在随访期内未发生髋关节脱位、深静脉栓塞、感染、股骨颈骨折等并发症。临床结果显示，Harris髋关节评分较术前显著提高，术后平均Harris评分为92.6分，术前平均Harris评分为48.5分。影像学资料显示所有假体在位，未观察到放射性透亮带。所有患者疼痛解除，髋关节活动度也明显改善，术后早期活动无任何受限。结论金属对金属髋关节表面置换术治疗重度股骨头坏死的早期临床效果满意，其远期效果仍有待于观察。     

Total hip arthroplasty and hip resurfacing arthroplasty in the very young patient

Severe hip arthritis in an adolescent or very young adult can be a devastating disability that affects all aspects of a patient’s life. Newer treatment strategies in pediatric orthopedic surgery and hip preservation potentially could lessen the impact of this severe disorder in the future. Careful patient selection can lead to excellent outcomes for both THA and/or HRA in young patients. Further study will likely shed more light on whether HRA truly has more improved functional results than THA, and studies with longer follow-up that show definitive revision rates also should affect the future of HRA.     

髋关节表面置换治疗股骨头坏死与非坏死髋病的中长期对比

[目的]对比并分析髋关节表面置换术(HRA)分别治疗股骨头坏死(ONFH)和非骨坏死髋疾病的中长期疗效。[方法] 2005年6月～2015年8月共有73例84髋于本院施行了HRA,其中,ONFH 21例(23髋)定义为ONFH组,其他非骨坏死髋疾病52例61髋,定义为非ONFH组。测量髋关节活动范围(ROM)和Harris评分。此外,患者接受髋关节X线片、CT或MR的影像学检查评估。[结果] ONFH组和非ONFH组假体5年生存率均为100%。两组术后髋关节ROM均分别显著大于术前(P0.05);尽管术前ONFH组患者的屈伸ROM小于非ONFH组(P0.05),但两组末次随访时的髋关节各向ROM差异均无统计学意义(P0.05)。两组间术前和末次随访时Harris评分差异无统计学意义(P0.05),但两组末次随访时Harris评分均较术前显著提高(P0.05)。ONFH组和非ONFH组股骨头囊性变直径、髋臼假体外展角和股骨假体柄干角的对比差异均无统计学意义(P0.05)。共有13例不需要翻修的并发症:ONFH组4例,非ONFH组9例,所有患者均无股骨颈骨折和感染等严重并发症。[结论] ONFH和其他病因的患者在HRA术后可获得相当且满意的假体生存率和临床疗效。HRA为需要接受髋关节置换且要求良好中长期疗效的患者提供了合适选择。     

全髋关节表面置换术治疗髋关节发育不良并发骨关节炎的初步体会

目的探讨全髋关节表面置换术(THRA)治疗髋关节发育不良(DDH)并发骨关节炎的可行性及注意事项。方法自2006～2009年,本组完成20例(23髋)THRA,其中DDH并发骨关节炎共11例(13髋),男4例(4髋),女7例(9髋);左髋5例次,右髋8例次;年龄平均(43.0±11.6)岁;术前Harris评分平均(56.9±17.8)分。按照KarlPerner法分度,13髋中Ⅰ度发育不良7髋,Ⅱ度发育不良3髋,Ⅲ度发育不良3髋。按照Hartofilakids法分度,Ⅰ度11髋,Ⅱ度2髋。采用金属对金属表面置换假体,股骨侧骨水泥固定、髋臼侧生物型固定。结果患者获得近期随访(0.5～2年),出院时及末次随访时间Harris评分同术前比较差异具有统计学意义。术前髋臼角(Sharp角)33.8～56.4°,平均(47.7±6.5)°;头颈比例1.29～1.64,平均(1.47±0.11);颈干角126.7～162.2°,平均(141.2±9.7)°;CE角-7.5～28.8°,平均(12.3±12.3)°。术后臼杯外展角22.4～69.3°,平均(46.8±12.9)°;假体柄干角126.8～159.1°,平均(143.0±9.2)°。髋臼假体完全被骨床覆盖6髋,外上缘外露小于0.5cm的2髋,外上缘外露超过0.5cm的5髋。1例患者术后2年随访时发现髋臼松动。结论对DDH并发骨关节炎的患者实施THRA,会面临头臼假体无法良好匹配、异常头颈比和异常颈干角等问题,加之患者髋臼表浅及髋臼角过大,容易导致术后假体位置不良,所以DDH导致的骨关节炎并非THRA的良好适应证。     

Thermal damage potential during hip resurfacing in osteonecrosis of the femoral head: An experimental study

Hip resurfacing arthroplasty has become an attractive treatment option for young, active patients with femoral head necrosis. However, little information is available about the potential thermal damage to the remaining femoral head when a cemented component is used. We used an experimental model to measure the temperature profile at the cement–bone interface during hip resurfacing. We compared four simulated lesion sizes—15, 25, 33, and 50%—of the femoral head, and a control group with no cystic lesion. Temperatures were measured with the specimens in a 37°C saline bath or with copious pulsed lavage. With specimens tested in the bath, peak temperatures were higher, and durations of temperatures above 50°C were longer, in femoral heads with necrotic lesions (88.8 ± 7.5°C; 17.6 ± 1.1 min for a 15% lesion; 96.2 ± 7.2°C; 22.86 ± 1.3 min for a 25% lesion; 99.7 © 200 ± 9.4°C; 28.6 ± 2.0 min for a 33% lesion; and 97.2 ± 4.2°C; 35.6 ± 2.4 min for a 50% lesion) than those in the control group (65.8 ± 4.9°C; 10.0 ± 1.3 min). The larger the cement‐filled cysts, the longer the temperatures remained above 50°C. Although copious lavage reduced the temperature profile in each group, the temperatures remained above 50°C for 7 to 17 min in specimens with necrotic cysts. The measured temperatures during surface replacement are sufficiently high in magnitude and long in duration to cause thermal damage to the remaining bone in femoral heads with preexisting necrotic lesions. Hip resurfacing for femoral head necrosis should be performed with caution. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1206–1209, 2008     

Failed internal fixation due to osteonecrosis following traumatic periprosthetic fracture after hip resurfacing arthroplasty

Background and purpose The Knee Injury and Osteoarthritis Outcome Score (KOOS) is distinguished from other knee-specific measures by the inclusion of separate scales for evaluation of activities of daily living, sports and recreation function, and knee-related quality of life, with presentation of separate subscale scores as a profile. However, its applicability in children has not been established. In this study, we examined how well the KOOS could be understood in a cohort of children with knee injury, with a view to preparing a pediatric version (KOOS-Child).

Material and methods A trained researcher conducted cognitive interviews with 34 Swedish children who had symptomatic knee injuries (either primary or repeated). They were 10–16 years of age, and were selected to allow for equal group representation of age and sex. All the interviews were recorded. 4 researchers analyzed the data and modified the original KOOS questionnaire.

Results Many children (n =14) had difficulty in tracking items based on the time frame and an equivalent number of children had trouble in understanding several terms. Mapping errors resulted from misinterpretation of items and from design issues related to the item such as double-barreled format. Most children understood how to use the 5-point Likert response scale. Many children found the instructions confusing from both a lexical and a formatting point of view. Overall, most children found that several items were irrelevant.

Interpretation The original KOOS is not well understood by children. Modifications related to comprehension, mapping of responses, and jargon in the KOOS were made based on qualitative feedback from the children.     

Core decompression for osteonecrosis of the hip

The ultimate goal of treatment of patients with osteonecrosis of the hip is preservation of the femoral head. However, the development of a successful strategy to treat this disease has been difficult because neither the etiology nor the natural history of osteonecrosis of the hip has been defined clearly. Core decompression of the hip is one of the most commonly done surgical procedures to treat the early stages of osteonecrosis of the femoral head. However, there is no general consensus among investigators regarding either the specific indications for this procedure, or the specific technique of core decompression that would optimize results. The data available suggest that core decompression is more effective than nonoperative treatment particularly for patients with limited involvement of the femoral head and with an area of sclerosis surrounding the necrotic bone. The combination of core decompression with the use of osteoinductive or angiogenic agents to enhance bone formation and repair may enhance the results of this surgical procedure in the future.     

Results of hip resurfacing

Background  

The renewed popularity of resurfacing hip arthroplasty in the last 10 years has generated a remarkable quantity of scientific contributions based on mid- and short-term follow-up. More than one paper has reported a consistent early revision rate as a consequence of biological or biomechanical failure. Two major complications are commonly described with resurfacing implants: avascular necrosis and femoral-neck fracture. A close relationship between these two events has been suggested, but not firmly demonstrated, whereas cementing technique seems to be better understood as potential cause of failure.     

Femoral head resurfacing for the treatment of osteonecrosis in the young patient

We reviewed the clinical and radiographic results of 29 consecutive femoral head resurfacing procedures in 28 patients with avascular necrosis done from February 1997 until April 2000. There were 18 males and 10 females with an average age of 31.6 years (range, 12-48 years). The average Harris hip score significantly improved from 48.1 points preoperatively to 79.3 points at last followup. At final followup, 17 patients (18 hips [62%]) reported feeling much better or better than they did before hemiresurfacing. The overall survivorship was 75.9% at 3 years. Eight hips (27.6%) were converted to a total hip arthroplasty (THA) at an average 18 months (range, 8-43 months) after resurfacing. The results of this study suggest that femoral head resurfacing in a young patient with ON can greatly improve symptoms. The majority of patients were satisfied with the procedure but outcomes are unpredictable with only 62.5% of patients reporting satisfaction and good pain relief at last followup. We continue to offer this procedure in young patients with large necrotic lesions with the understanding that this procedure provides somewhat unpredictable pain relief; however, hemiresurfacing avoids the negatives associated with a bearing surface.     

Total hip arthroplasty for osteonecrosis: Matched-pair analysis of 188 hips with long-term follow-up

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.