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      Hip resurfacing arthroplasty for osteonecrosis of the femoral head: Implant-specific outcomes and risk factors for failure

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          Abstract

          Background

          Hip resurfacing arthroplasty (HRA) may be a suitable option for treating osteonecrosis of the femoral head (ONFH). However, concerns regarding the extent of osteonecrosis, amount of defect under the prosthesis, and implant-related complications remain. This study aimed to report implant-specific outcomes and risk factors for failure of HRA in ONFH.

          Methods

          A total of 202 HRAs (166 patients) performed by a single surgeon were investigated. The stage, size, and location of ONFH were evaluated using preoperative radiographs and magnetic resonance images. Clinical, radiographic results, and serum metal concentrations of articular surface replacement (ASR) and non-ASR devices were compared. Logistic regression analysis was performed to identify the contributors of failures. The mean follow-up duration was 10.6 years.

          Results

          Twenty-six hips (12.9%) were operated with Birmingham Hip Resurfacing (BHR), 99 (49.0%) with ASR, and 77 (38.1%) with Conserve Plus. The mean Harris Hip Score improved from 52.1 to 93.2 at the final follow-up (P < 0.001). Revision-free survivorships of non-ASR and ASR implants were 99.0% and 82.4%, respectively (P < 0.001). In multivariate analysis, the use of ASR prosthesis, greater combined necrotic angle, and smaller head size were associated with revision surgery. A large combined necrotic angle was the only independent risk factor for mechanical failure at the femoral side (P = 0.029).

          Conclusion

          HRA for ONFH using BHR and Conserve Plus implants demonstrated favourable clinical outcomes with high revision-free survival rates at 10 years. However, care should be taken for large necrotic lesions that can lead to femoral neck fracture or aseptic femoral loosening.

          The translational potential of this article

          This study suggests HRA performed for appropriately selected patients with ONFH can show excellent long-term clinical results. Therefore, HRA should remain as one of the treatment options for ONFH, and further development of HRA implants should be continued.

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          Most cited references38

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          The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head.

          Toshikazu Kubo, Nobuhiko Sugano, Kenji Ohzono … (2001)
          The 2001 revised criteria for the diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head were proposed in June 2001, by the working group of the Specific Disease Investigation Committee under the auspices of the Japanese Ministry of Health, Labor and Welfare, to establish criteria for diagnosis and management of idiopathic osteonecrosis of the femoral head. Five criteria that showed high specificity were selected for diagnosis: collapse of the femoral head (including crescent sign) without joint-space narrowing or acetabular abnormality on x-ray images; demarcating sclerosis in the femoral head without joint-space narrowing or acetabular abnormality; "cold in hot" on bone scans; low-intensity band on T1-weighted MRI (bandlike pattern); and trabecular and marrow necrosis on histology. Idiopathic osteonecrosis of the femoral head is diagnosed if the patient fulfills two of these five criteria and does not have bone tumors or dysplasias. Necrotic lesions are classified into four types, based on their location on T1-weighted images or x-ray images. Type A lesions occupy the medial one-third or less of the weight-bearing portion. Type B lesions occupy the medial two-thirds or less of the weight-bearing portion. Type C1 lesions occupy more than the medial two-thirds of the weight-bearing portion but do not extend laterally to the acetabular edge. Type C2 lesions occupy more than the medial two-thirds of the weight-bearing portion and extend laterally to the acetabular edge. Staging is based on anteroposterior and lateral views of the femoral head on x-ray images. Stage 1 is defined as the period when there are no specific findings of osteonecrosis on x-ray images, although specific findings are observed on MRI, bone scintigram, or histology. Stage 2 is the period when demarcating sclerosis is observed without collapse of the femoral head. Stage 3 is the period when collapse of the femoral head, including crescent sign, is observed without joint-space narrowing. Mild osteophyte formation in the femoral head or acetabulum may be observed in stage 3. Stage 3 is divided into two substages. In stage 3A, collapse of the femoral head is less than 3 mm. In stage 3B, collapse of the femoral head is 3 mm or greater. Stage 4 is the period when osteoarthritic changes are observed.
          Article 0 comments Cited 108 times – based on 0 reviews     Review now
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            Patterns of osteolysis around total hip components inserted with and without cement.

            C Anderson Engh, B Zicat, E Gokcen (1995)
            We reviewed the radiographs of 137 patients (137 hips) who had been managed with a total hip arthroplasty, with insertion of an extensively porous-coated femoral component without cement, because of osteoarthrosis or avascular necrosis. A porous-coated acetabular component had been inserted with cement in sixty-three of these patients (Group A) and without cement in seventy-four patients (Group B). The radiographs were examined for osteolysis, either directly adjacent to the joint or at locations remote from the joint. The mean duration of follow-up was 105 months (range, fifty-four to 142 months). The rate of osteolysis of the acetabulum in the unrevised hips in which the acetabular component had been inserted with cement was 37 per cent (nineteen of fifty-one). The osteolysis was most frequently of the linear type, a pattern that was associated with a high prevalence of loosening in the hips that had a cemented cup (30 per cent [nineteen of sixty-three]). The rate of acetabular osteolysis (18 per cent [thirteen of seventy-one]) in the patients who had a cup that had not been inserted with cement and that had not been revised was not as high as that associated with the surviving cups that had been inserted with cement (p < 0.05). The osteolysis associated with the cups that had not been inserted with cement was localized and expansile, and it was not associated with loosening of the component. However, it produced more loss of bone than did the linear pattern of osteolysis around the cemented cups.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images.

              Yong-Chan Ha, Woon Jung, Jang-Rak Kim … (2006)
              The hypothesis that the combined necrotic angle measurement from magnetic resonance imaging scans predicts the subsequent risk of collapse in hips with femoral head necrosis was tested.
              Article 0 comments Cited 40 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Youn-Soo Park
                Journal
                Journal ID (nlm-ta): J Orthop Translat
                Journal ID (iso-abbrev): J Orthop Translat
                Title: Journal of Orthopaedic Translation
                Publisher: Chinese Speaking Orthopaedic Society
                ISSN (Print): 2214-031X
                ISSN (Electronic): 2214-0328
                Publication date PMC-release: 06 January 2020
                Publication date Collection: March 2020
                Publication date (Electronic): 06 January 2020
                Volume: 21
                Pages: 41-48
                Affiliations
                [1]Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
                Author notes
                [∗ ]Corresponding author. Department of Orthopedic Surgery, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea. ysp3504@ 123456skku.edu
                [☆]

                Chan-Woo Park and Seung-Jae Lim equally contributed to this work and share first authorship.

                Article
                Publisher ID: S2214-031X(19)30264-5
                DOI: 10.1016/j.jot.2019.12.005
                PMC ID: 7016032
                SO-VID: f1d494f1-3574-4710-9e1d-321b18f73954
                Copyright © © 2019 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 8 August 2019
                Date revision received : 6 November 2019
                Date accepted : 10 December 2019
                Categories
                Subject: Original Article

                Keywords: hip resurfacing arthroplasty,implant-specific outcome,mechanical failure,osteonecrosis of the femoral head,risk factors
                Data availability:
                Keywords: hip resurfacing arthroplasty, implant-specific outcome, mechanical failure, osteonecrosis of the femoral head, risk factors

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