Background: Recently, with the advent of improved metal-on-metal
prostheses, total hip resurfacing has emerged as a viable arthroplasty option.
However, it remains controversial whether this procedure should be used in
patients with osteonecrosis when the femoral resurfacing component is cemented
onto dead bone. The purpose of this study was to analyze the clinical and
radiographic outcomes of metal-on-metal total hip resurfacing arthroplasty in
patients with osteonecrosis of the femoral head. In addition, this group was
compared with a matched group of patients who were diagnosed as having
Methods: Forty-two osteonecrotic hips that were treated with a
metal-on-metal total hip resurfacing arthroplasty were studied. They were
matched by gender, age, prosthesis, surgeon, and surgical approach to
forty-two osteoarthritic hips that were treated with the same metal-on-metal
prosthesis. In the osteonecrosis group, there were twenty-five men and eleven
women, and in the osteoarthritis group, there were twenty-eight men and
thirteen women. The mean age at the time of surgery was forty-two years.
Patients were followed both clinically and radiographically for a mean of
Results: The clinical outcomes were similar for both groups, with a
good or excellent outcome in thirty-nine hips (93%) with osteonecrosis and a
good or excellent outcome in forty-one hips (98%) with osteoarthritis. In each
of the two groups, there were two failures that required conversion to a
standard total hip arthroplasty. Survivorship curves were similar for the two
Conclusions: The short-term results for metal-on-metal total hip
resurfacing for this challenging patient population with osteonecrosis were
excellent and comparable with those seen in patients with osteoarthritis. We
await long-term results to see if these early results are maintained.
Level of Evidence: Prognostic Level II. See Instructions
to Authors on
jbjs.org for a
complete description of levels of evidence.