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Uncemented Total Hip Arthroplasty in Patients with a History of Pelvic Irradiation for Prostate Cancer
Kang-Il Kim, MD, PhD1; Gregg R. Klein, MD1; Joshua Sleeper, BA1; Adam P. Dicker, MD, PhD2; Richard H. Rothman, MD, PhD1; Javad Parvizi, MD, FRCS1
1 Rothman Institute of Orthopedics, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for J. Parvizi: parvj@aol.com
2 Department of Radiation Oncology, Thomas Jefferson University Hospital, G301 North Bodine Center, 111 South 11th Street, Philadelphia, PA 19107
View Disclosures and Other Information
Dislcosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Stryker Orthopaedics. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker Orthopaedics). Also, a commercial entity (Stryker Orthopaedics) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Rothman Institute of Orthopedics and the Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Apr 01;89(4):798-805. doi: 10.2106/JBJS.F.00183
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Background: Pelvic irradiation for a malignant tumor may cause osteonecrosis of the acetabulum. The purpose of this study was to evaluate the outcome of uncemented total hip arthroplasty in patients with a history of pelvic irradiation for the treatment of prostate cancer.

Methods: We performed a retrospective review of the clinical records and radiographs of fifty-eight patients (sixty-six hips) who had had radiation therapy for prostate cancer and had subsequently undergone an elective primary uncemented total hip arthroplasty at our institution. The mean age of the patients at the time of the index operation was seventy-four years. The mean duration of follow-up was 4.8 years (range, two to 7.5 years).

Results: At the time of the final follow-up, fifty-one patients (fifty-eight hips) who were still living and had been followed for a minimum of two years had a well-ingrown and functioning replacement. The mean Harris hip score had significantly improved from 47 points preoperatively to 90 points at the time of the final follow-up (p < 0.05). The mean scores on the physical and mental health measures of the Short Form-36 had also improved significantly from 45.1 and 65.3 points, respectively, before the operation to 73.4 and 83.7 points postoperatively (p < 0.05 for both). There was no aseptic loosening of either component in any of the hips. Two hips had revision of the femoral component; one was revised because of a periprosthetic fracture of the femur and the other because of subsidence of the femoral component.

Conclusions: Uncemented total hip arthroplasty can be a successful option for the treatment of coxarthrosis in patients with a history of pelvic irradiation for prostate cancer. Osseointegration of uncemented components does not seem to be compromised in these patients in the short term.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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