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Osteonecrosis of the Femoral Head Treated with Cementless Total Hip Arthroplasty*
William T. Hartley, M.D.†; James P. McAuley, M.D.†; William J. Culpepper, M.S.†; C. Anderson EnghJr., M.D.†; Charles A. Engh, Sr., M.D.†
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Investigation performed at the Anderson Orthopaedic Research Institute, Alexandria, Virginia
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
†Anderson Orthopaedic Research Institute, P.O. Box 7088, Alexandria, Virginia 22307.

J Bone Joint Surg Am, 2000 Oct 01;82(10):1408-1408
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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 with osteonecrosis.

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    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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