Cementless hip arthroplasty in the treatment of patients with femoral headnecrosis

Treatment of patients with osteonecrosis of the femoral head focuses on pai n relief and improved function of the hip. Total hip arthroplasty remains a n effective tool for the treatment of patients with end-stage osteonecrosis with collapse of the femoral head, although there is a greater risk for fa ilure. The aim of the current study was to assess the long-term survival of cementless total hip arthroplasties in 28 patients (36 hips) with osteonec rosis of the femoral head (Steinberg Stage V and Stage VI) with an average followup of 11.2 years (range, 10-15 years). There were 19 women and nine m en with an average age of 51.4 years (range, 28-65 years). A threaded titan ium cup CST (Conical Screwed Titanium) was used in all patients and differe nt cementless femoral components were used depending on the optimal fit in the femoral canal as assessed during preoperative templating, No serious co mplications were encountered postoperatively. The patients were evaluated p reoperatively and postoperatively with the Merle d'Aubigne and Postel scale . After cementless total hip arthroplasty, the average pain score improved 3.6 points, walking ability improved 1.6 points, and range of motion improv ed 1 point. Two patients had thigh pain. Radiographic evaluation on anterop osterior and lateral radiographs of the proximal femur was excellent in 10 hips postoperatively. No heterotropic ossification was observed, although p roximal femoral atrophy was seen in 15 hips. Clinical and radiologic findin gs did not correlate. There were two revisions of the acetabular implants i n one patient with bilateral idiopathic osteonecroses and total hip replace ment. Overall, survival of the prostheses was 93.4% at the average followup of 11.2 Sears.