Femoral Head Osteonecrosis Treatment Methods   |    
Metal-on-Metal Hip Resurfacing in Osteonecrosis of the Femoral Head
Matthew P. Revell, FRCS(Tr&Orth); Callum W. McBryde, MRCS; Sharad Bhatnagar, MRCS; Paul B. Pynsent, PhD; Ronan B.C. Treacy, FRCS(Tr&Orth)
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In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the British Hip Society (The McMinn Scholarship). The authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Smith and Nephew PLC and Midland Medical Technologies). A commercial entity (Smith and Nephew PLC) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Nov 01;88(suppl 3):98-103. doi: 10.2106/JBJS.F.01070
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Background: The treatment of end-stage osteonecrosis of the femoral head remains a challenge to the orthopaedic surgeon. Historically, total hip arthroplasty for this condition has been associated with poor rates of survival and function when compared with total hip arthroplasty for the treatment of osteoarthritis. The purpose of this study was to determine the medium-term clinical and radiographic results of metal-on-metal hip resurfacing arthroplasty in patients with end-stage osteonecrosis of the femoral head.

Methods: From June 1994 to March 2004, a consecutive single-surgeon series of seventy-three hip resurfacing procedures were performed in sixty patients for the treatment of end-stage osteonecrosis of the femoral head. The cohort included forty-two men (ten of whom had a bilateral resurfacing) and eighteen women (three of whom had a bilateral resurfacing). The mean age was forty-three years (range, seventeen to sixty-nine years). A clinical and radiographic review was performed.

Results: There were four revision operations and one planned revision of the seventy-three hips during the follow-up period. Two of these revisions were necessitated by aseptic failure of the femoral component. This represents an overall survival rate of 93.2% at a mean of 6.1 years of follow-up (range, two to twelve years).

Conclusions: On the basis of this study, metal-on-metal resurfacing of the hip for osteonecrosis can be considered a safe and effective form of surgery for this group of patients. Longer-term follow-up is required to confirm the expected continued success of this form of arthroplasty in this difficult-to-treat population.

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

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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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