To The Editor:
In regard to "Osteonecrosis of the Femoral Head Treated
with Cementless Total Hip Arthroplasty" (82-A: 1408-13,
Oct. 2000), by Hartley et al., it has been well established in the
literature that total hip replacement as a treatment for osteonecrosis
of the hip has not been as successful as it has for other diagnoses,
even within the same age-group1.
Better cementing techniques, as well as cementless fixation, have
had promising results of improved durability in this younger patient
population2,3. As long-term results
become available for this patient population, as in this study of
cementless fixation, we will be able to compare these results with
the results of total hip replacements documented in the literature
for this patient population and with those of more conservative
treatments. For purposes of comparison with the published literature,
survivorship curves are essential4,5.
In that respect, it is difficult for us to understand why a survivorship
curve was not provided in this paper.
Also, we have a question regarding the incidence of dislocation.
The authors mention that their series had three recurrent dislocations,
but were there any other dislocations that were not recurrent?
We thank the authors again for sharing their very important results
in this young patient population.
W.T. Hartley, J.P. McAuley, W.J. Culpepper II, C.A. Engh
Jr., and C.A. Engh Sr. reply:
We are pleased to respond to the letter by Drs. Beaulé and
Dorey concerning our recent article.
A Kaplan-Meier analysis, with component revision for
any reason as an end point, showed that the rate of survival was
93.5% ± 7.1% at five years
and 79.7% ± 13.0% at ten
years (95% confidence intervals).
In the paper, we reported that three hips were revised for recurrent
dislocation. We are aware of no other dislocations in this patient
population.