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Endoprostheses for osteonecrosis of the femoral head

A comparison of four models in young patients

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Summary

Eighty-eight hip arthroplasties were carried out in 75 patients, all aged 50 years or less, with osteonecrosis. All the operations were carried out by one surgeon. Four different methods were used: a standard cemented arthroplasty; a cemented THARIES surface replacement; an uncemented surface replacement; a cemented titanium femoral surface hemiarthroplasty. Comparable clinical improvement occurred in all 4 groups initially. Aseptic loosening, with intersurface degradation and osteolytic lesions, was the most common cause of failure in the 3 types which had a polythene bearing. Polyethylene is the major contributor to bone loss around the endoprosthesis and loosening. Fixation of the surface hemiarthroplasty remained intact in every patient and failure was secondary to wear of the acetabular cartilage. We recommend surface hemiarthroplasty as an interim solution for young patients with stage III or early stage IV osteonecrosis because this procedure conserves bone stock, there is little osteolysis and it can easily be revised.

Résumé

Quatre-vingt-huit prothèses de hanche chez 75 patients atteints d'ostéonécrose et âgés de 50 ans ou moins ont été faites par un seul chirurgien. Vingt patients (24 hanches) ont été traités par une prothèse conventionelle cimentée. Il y eut 6 révisions, en moyenne à 87 mois. Trente et un patients (35 hanches) furent traités par une cupule couplée cimentée THARIES. Vingt deux révisions furent nécessaires, en moyenne à 84 mois. Un remplacement de surface sans ciment a été utilisé chez 19 patients, dont 10 furent réopérés à 60 mois en moyenne. Neuf patients (10 hanches) furent traités avec une hémi-arthroplastie fémorale de surface en titane, cimentée. 5 d'entre-eux ont dû être réopérés à un délai moyen de 89 mois. L'amélioration fonctionnelle a été comparable dans les 4 groupes. Dans les 3 groupes ayant une surface de frottement en polyéthylène, le descellement aseptique avec lésions d'ostéolyse fut la cause la plus fréquente d'échec. La fixation de l'hémi-arthroplastic fémorale ne s'est pas dégradée, et les échecs survinrent secondairement à cause de l'usure du cartilage acétabulaire. Ceci suggère que le polyéthylène est le facteur principal de l'ostéolyse péri-prothétique et du descellement. Avec l'avantage de la conservation osseuse, de l'absence d'ostéolyse et la facilité de la reprise, nous recommandons l'hémiarthroplastie de surface comme solution temporaire chez le jeune patient atteint d'une ostéonécrose au stade III ou IV précoce.

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Authors and Affiliations

  1. Joint Replacement Institute, Orthopaedic Hospital, 90007, Los Angeles, CA, USA

    M. J. Grecula (Medical Director), P. Grigoris, T. P. Schmalzried, F. Dorey, P. A. Campbell & H. C. Amstutz

  2. Harbor-UCLA Medical Centre, Torrance, CA, USA

    T. P. Schmalzried

  3. UCLA Medical Centre, 90007, Los Angeles, CA, USA

    F. Dorey

Authors
  1. M. J. Grecula
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  2. P. Grigoris
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  3. T. P. Schmalzried
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  4. F. Dorey
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  5. P. A. Campbell
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  6. H. C. Amstutz
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Grecula, M.J., Grigoris, P., Schmalzried, T.P. et al. Endoprostheses for osteonecrosis of the femoral head. International Orthopaedics 19, 137–143 (1995). https://doi.org/10.1007/BF00181858

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