Mid-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head

Abstract

Purpose: To evaluate the clinical and radiographic mid-term results of short-stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH).

Methods: We reviewed 83 cases that underwent Metha stem between November 2010 and November 2012. The appearance of bone trabeculae development and radiolucent line were reviewed and HHS was recorded at 6 months postoperatively then yearly to evaluate the clinical results.

Results: The mean age of patients was 43.8 years with the mean follow-up 69.3 (60-84) months. Harris Hip Score improved significantly from 44.7 preoperatively to 99.6 at the last follow-up (p < 0.0001). There were 4 cases (4.8%) of intraoperative femoral fractures. There was 1 case (1.2%) of distal stem perforation that had stable bone ingrowth and there was 1 case (1.2%) of 5-mm subsidence, which was then stable at 3 months postoperatively. Bone trabecular development was detected at zone 1 (65.1%), 2 (69.9%), 3 (14.4%), 4 (1.2%), 6 (97.6%) and 7 (81.9%). There was 1 case (1.2%) where radiolucent lines were observed in zones 1 and 7. There was 1 femoral stem revision from periprosthetic fracture 4 years after index surgery and 1 cup revision from aseptic loosening. Kaplan-Meier survivorship with the end point of stem revision for any reason was 98.8% and for aseptic loosening it was 100% at 7 years.

Conclusions: The mid-term clinical and radiographic results of the Metha stem in patients with ONFH were promising. Its design enables preservation of the bone stock and the bone trabeculae appear to confirm the assumption of proximal force transmission.

Keywords: Metaphyseal anchorage; ONFH; THA; osteonecrosis of the femoral head; short-stem arthroplasty; total hip arthroplasty.