Long-term results of bipolar hemiarthroplasty for osteoarthritis of the hip and idiopathic osteonecrosis of the femoral head.
ABSTRACT Satisfactory results have been reported from long-term studies on bipolar hemiarthroplasty for femoral neck fracture. However, long-term results of this procedure for osteoarthritis of the hip (OA) and idiopathic necrosis of the femoral head (ION) have given rise to pessimism. These poor results have often reported migration of the bipolar head, but few had described the direction of this migration. The purpose of the present study was to conduct a long-term follow-up analysis of bipolar hemiarthroplasty for OA and ION, including the direction of migration.
We retrospectively reviewed a consecutive series of 64 patients (76 hips) who underwent primary bipolar hemiarthroplasty for symptomatic OA and ION with a cementless femoral component between 1976 and 1995. Of these 64 patients, 35 patients (40 hips) were available for clinical and radiographic review at a minimum follow-up duration of 10 years.
The Japanese Orthopaedic Association score significantly improved and pain relief was high following surgery; however, preservation of acetabular bone stock could not be achieved because of migration. The survival rate declined 10 years after surgery. Superomedial migration was found to be a risk factor for revision, and one factor affecting superomedial migration was the postoperative center edge angle.
The long-term results of bipolar hemiarthroplasty for OA and ION are not favorable. If a sufficient centripetal position is obtained with reaming, the bipolar head tends to migrate superomedially, subsequently requiring revision.
- SourceAvailable from: synapse.koreamed.orgThe Journal of the Korean Orthopaedic Association 01/2010; 45(4).
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ABSTRACT: Bipolar hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral head (ONFH) is performed at our institution. The purpose of this study was to evaluate the clinical and radiographic findings after BHA for the treatment of steroid -induced ONFH. Thirty-seven hips in 27 patients were assessed (seven men, 11 hips; 20 women, 26 hips), average patient age at the time of surgery of 42.6 (range 20-83) years, with steroid-induced ONFH treated with BHA between 1995 and 2005. The mean follow-up duration was approximately ten (range five to15) years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. Kaplan-Meier survivorship was calculated to examine revision arthroplasty failure rate. Radiographic analysis of loosening included radiolucent lines and osteolysis of the acetabulum or femur. Causes of loosening were analysed using multiple logistic regression. JOA hip score increased from 53 points (preoperative) to 87 points (final follow-up). Survival rates were 96.8 % and 78.6 % at ten and 15 years, respectively. Prosthesis loosening occurred on the acetabular side in five hips (13.5 %). No femoral-component loosening was observed. BHA had poor results in patients with Association Research Circulation Osseous (ARCO) stage IV ONFH and in patients under 40 years of age. BHA, with strict surgical indications, may be a good option for treating ONFH. Based on these results, total hip arthroplasty is recommended for patients with ARCO stage IV ONFH or for patients under 40 years of age.International Orthopaedics 07/2012; 36(10):2041-7. · 2.32 Impact Factor
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ABSTRACT: First metatarsophalangeal (MTP) joint arthrodesis has proven to be a reliable procedure for pain relief and functional improvement for treatment of first MTP joint arthritis. This outlines the indications, techniques, success and failures of the first MTP joint arthrodesis and first MTP joint arthroplasty. The author provides critical observations based on opinion gathered from clinical and academic experience.Current Orthopaedic Practice 04/2010; 21(3):258-263.