[Surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis]

Zhong Yu, Li-Ming Wang, Jian-Chao Gui, Jun-Xian Wu, Chun-Zhi Jiang, Yan Xu
Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology 2008, 21 (1): 35-7

OBJECTIVE: To evaluate the outcome and indication of surface-replacement total hip arthroplasty in the treatment of the femoral head osteonecrosis.

METHODS: The clinical data of 17 patients (21 hips) with femoral head osteonecrosis were reviewed. Among which, 10 cases were male and 7 cases were female, the average age was 36 years old (ranging from 25 to 51 years). There were 8 hips at Ficat stage III and 10 hips at Ficat stage IV. The 17 patients (21 hips) underwent surface-replacement total hip arthroplasty. Gibson posterolateral incision was used and non-cemented prosthesis was implanted. For prosthetic femoral head fixation, a guide pin was inserted into the capital center. After hollow boring hit drilling, a guide pole was inserted, and redundancy of femoral head was rasped off with cutterbar. The bone cement was painted on the femoral head and prosthesis, and the prosthesis was planted into the central axis hole of neck of femur until bone cement solidification. The therapeutic effects were evaluated by Harris hip score and statistical analysis was made. The X-ray was rechecked regularly.

RESULTS: The mean duration of follow-up was 32 months (18 to 42 months). The average Harris hip score was improved significantly from preoperative 35.30 +/- 5.23 to postoperative 90.47 +/- 3.14, and the excellent and good rate was 90.5%. There were high statistical differences between preoperative and postoperative Harris score (P < 0.01). The X-ray showed radiolucent line around acetabular prostheses in two patients but without prostheses loosening.

CONCLUSION: Surface-replacement total hip arthroplasty is a satisfactory way for the treatment of femoral head osteonecrosis in the middle-late phase, which can help reconstructing normal joint biomechanics and load transmission,improving joint stability and postponing THA without affecting later rebuilding, as well as some advantages such as decreasing surgical wound, convenient and low infection rate. Its indication is Ficat stage III and part Ficat stage IV femur head necrosis with less destroyed neck of femur,especially for young patients having a large amount of activity.

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