EVALUATION OF UNCEMENTED TOTAL HIP-ARTHROPLASTY IN PATIENTS WITH AVASCULAR NECROSIS OF THE FEMORAL-HEAD

Thirty-seven uncemented primary porous coated anatomic (PCA) total hip arthroplasties (THA) that were performed in 33 patients for the diagn osis of avascular necrosis (AVN) between June 1984 and December 1986 w ere reexamined at four- to six-year follow-up periods. Final clinical evaluation showed an 86-point average Harris hip rating (range, 47-100 points), which had improved from an average preoperative rating of 42 points (range, 20-61 points). Thigh pain, which was usually not funct ionally limiting, occurred in 11 patients (25%), and seven patients (1 6%) had a moderate or severe limp. Nine patients (20%) required the us e of a cane. Long-term radiographic evaluation in 37 hips demonstrated acetabular cup migration in one hip, acetabular lucencies in four hip s (11%), and acetabular bead loosening in ten hips (27%). Femoral subs idence occurred in five hips (14%) and femoral bead loosening in 11 hi ps (30%). Thirty hips (81%) demonstrated radiographic evidence of stab le bony ingrowth. No revisions were performed for aseptic loosening, b ut two prostheses were removed for infection. These results of uncemen ted THA in patients with AVN appear to be as good or better than the r esults reported for cemented arthroplasty in AVN at this interval of a follow-up period, This study supports the use of uncemented devices, especially with the newer designs and increasing surgical experience i n this difficult patient population.