Minimum ten-year follow-up of cemented total hip replacement in patients with osteonecrosis of the femoral head

Abstract

Between November 1970 and September 1984 the senior author performed fifty-three consecutive total hip arthroplasties with cement in forty-one patients with the diagnosis of osteonecrosis of the femoral head. Five hips in three patients with failed renal transplants requiring chronic hemodialysis were excluded. At the time of final review, a minimum of ten years after the procedure, twenty-one patients (twenty-eight hips) were living, fifteen patients (eighteen hips) had died, and two patients (two hips) were lost to follow-up. A minimum ten-year follow-up radiograph was obtained on twenty-two (79%) of the hips in surviving patients. During the follow-up period 17.4% of hips (eight hips) required revision: 13.0% (six hips) for aseptic loosening, 2.2% (one hip) for sepsis, and 2.2% (one hip) for recurrent dislocation. All eight revisions occurred in patients living at time of final review, giving a revision prevalence of 22.9% (17.1% for aseptic loosening, 2.9% for sepsis, and 2.9% for recurrent dislocation) in patients surviving ten years. The prevalence of revision of the femoral component for aseptic loosening was 6.5% (three hips) for all hips and 9.1% (three hips) in patients surviving at least ten years. The prevalence of femoral aseptic loosening, defined as those components revised for aseptic loosening and those that demonstrated definite or probable radiographic loosening, was 13.0% (six hips) for all hips and 28.6% (six hips) for hips with at least ten-year radiographic follow-up. The prevalence of revision of the acetabular component for aseptic loosening was 13.0% (six hips) for all hips and 18.2% (six hips) in patients surviving at least ten years. The prevalence of acetabular aseptic loosening was 15.2% (seven hips) for all hips and 29.2% (seven hips) for hips with at least ten-year radiographic follow-up. In patients with osteonecrosis of the femoral head survivorship was significantly inferior to that in the senior author's overall patient population with regard to revision for aseptic loosening (p=0.019), revision for acetabular loosening (p=0.01), revision for femoral loosening (p=0.008), and aseptic femoral loosening (p=0.004). Survivorship to aseptic acetabular loosening was not significantly different (p=0.32). Young age at the time of surgery significantly increased the risk of subsequent component loosening (p<0.008) and revision due to aseptic loosening (p<0.002). These findings demonstrate the relatively poor durability of cemented total hip arthroplasty in patients with osteonecrosis of the femoral head as compared to patients with other diagnoses and suggest that the younger age in this patient population compromises results.

Figure 1A. Revision

Figure 1B. Revision for Aseptic Loosening

Figure 1C. Revision for Acetabular Loosening

Figure 1D. Revision for Femoral Loosening

Figure 1E. Acetabular Loosening

Figure 1F. Femoral Loosening

Figure 2A

Preoperative radiograph of fifty-one year old male with bilateral idiopathic osteonecrosis of the femoral head who had undergone bilateral tibial strut bone grafting.

Figure 2B

Postoperative radiograph following bilateral cemented total hip arthroplasty using Charnley prostheses.

Figure 2C

Thirteen year follow-up radiograph showing no evidence of component loosening.

Figure 3A

Preoperative radiograph of fifty-three year old alcoholic male with bilateral osteonecrosis of the femoral head.

Figure 3B

Postoperative radiograph following bilateral cemented total hip arthroplasty using Iowa prostheses.

Figure 3C

Eleven year follow-up radiograph demonstrates showing loosening of the right femoral component with a new lucency at the prosthesis-cement interface and medial femoral calcar osteolysis. Note also the fretting of cable used to reattach the trochanters.