Background: The treatment of young patients
who have osteonecrosis of the femoral head associated with collapse
or substantial secondary degeneration remains a therapeutic challenge,
with total hip arthroplasty being a treatment of choice. However, concerns
about the durability of the results of hip arthroplasty in this
population necessitate long-term evaluation of this treatment option.
To determine its advantages and limitations, we evaluated the results
of cementless total hip arthroplasty in a consecutive series of
young patients with advanced osteonecrosis.
Methods: We reviewed the results of fifty-five
consecutive primary total hip arthroplasties, after an average of 117
months of follow-up, in forty-five patients with a preoperative
diagnosis of advanced osteonecrosis of the femoral head (Ficat and
Arlet stage III or IV). The average age was thirty-one years (range,
twenty-one to forty years) at the time of the operation. We collected
data prospectively with the use of patient questionnaires and radiographs.
Results: Five patients died and one patient
was lost to follow-up before the time of the minimum five-year follow-up;
this left forty-eight hips in thirty-nine patients for inclusion
in the study. Ten (21 percent) of the forty-eight hips required
revision. No revisions were due to aseptic failure of the femoral component.
Of the remaining twenty-nine patients (thirty-eight hips), twenty-seven
(93 percent) reported few or no functional limitations and twenty-three
(79 percent) could walk an unlimited distance at the time of the
latest follow-up. Pain was absent or mild in twenty-five patients
(86 percent). Twenty-three patients (79 percent) were employed full-time.
Radiographically, thirty-seven femoral components (97 percent) were
bone-ingrown and the remaining component was judged to be fibrous
stable. All thirty-eight acetabular components were bone-ingrown.
Conclusions: Cementless total hip arthroplasty
remains a reasonable treatment option for advanced osteonecrosis
of the femoral head. Wear of the bearing surface continues to limit
the long-term success rate, but we are encouraged by the predictable long-term
stability of the bone-implant interface achieved with cementless
fixation. These results compare favorably with those of published
reports of total hip arthroplasty with cement in younger patients