Cementless Total Hip Arthroplasty in Patients with Osteonecrosis After Kidney Transplantation

Department of Orthopaedic Surgery, Asan Medical Center, Seoul, South Korea.
The Journal of arthroplasty (Impact Factor: 2.67). 03/2013; 28(5). DOI: 10.1016/j.arth.2013.01.020
Source: PubMed


This study was to determine the mid- to long-term survivorship of cementless metal-on-metal THA in 52 patients (74 hips) who underwent THA for osteonecrosis of the femoral head with a cementless THA. The mean follow-up was 10.2years. The mean age at operation was 42.1years (range, 25-62years). The survivorship analysis with revision as the end point estimated a 96.6% chance of THA survival during 16.4years. The average Harris hip score at last follow-up was 89.2 points (range, 74-100). Two patients (two hips) required revision surgery for extensive acetabular osteolysis at 9years and acetabular liner dissociation at 2years. The survival rates of cementless THA in these patients are encouraging. However, the possibility of metallic wear related complications are raising concern.

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    ABSTRACT: Symptomatic hip osteonecrosis is a disabling condition with a poorly understood aetiology and pathogenesis. Numerous treatment options for hip osteonecrosis are described, which include non-operative management and joint preserving procedures, as well as total hip replacement (THR). Non-operative or joint preserving treatment may improve outcomes when an early diagnosis is made before the lesion has become too large or there is radiographic evidence of femoral head collapse. The presence of a crescent sign, femoral head flattening, and acetabular involvement indicate a more advanced-stage disease in which joint preserving options are less effective than THR. Since many patients present after disease progression, primary THR is often the only reliable treatment option available. Prior to the 1990s, outcomes of THR for osteonecrosis were poor. However, according to recent reports and systemic reviews, it is encouraging that with the introduction of newer ceramic and/or highly cross-linked polyethylene bearings as well as highly-porous fixation interfaces, THR appears to be a reliable option in the management of end-stage arthritis following hip osteonecrosis in this historically difficult to treat patient population. Cite this article: Bone Joint J 2013;95-B, Supple A:46-50.
    Preview · Article · Nov 2013 · Bone and Joint Journal
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    ABSTRACT: Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hard-on-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-on-ceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace.
    No preview · Article · Jul 2014 · Clinical Orthopaedics and Related Research
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    ABSTRACT: Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill‑defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made.
    Full-text · Article · Nov 2014 · Indian Journal of Orthopaedics
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