Cementless total hip arthroplasty in post-traumatic avascular necrosis of the femoral head in young adults

Abstract

BackgroundTotal hip arthroplasty (THA) remains the only effective solution in advanced stages of avascular necrosis (AVN); however, in the long run, this intervention in younger individuals is associated with higher failure rates when compared with the same performed in an older population. Our prospective study evaluates the effectiveness of THA in a young group of patients with post-traumatic AVN.Patients and methodsTwenty-four patients (19 male, five female) with a mean age of 38 years (range 33-45 years) who had traumatic AVN of the femoral head were operated upon between January 2004 and May 2009. Unilateral cementless THA was performed for all patients. The indications for surgery were severe pain and loss of function in the hip. Plain radiography was used for diagnosis in all cases, and a computed tomography scan was needed in cases of acetabular fractures. In 12 patients, AVN occurred after an internal fixation of acetabular fractures: proximal femoral fracture in eight patients and hip dislocation in four patients.ResultsThe mean Harris hip score improved from 40 (preoperatively) to 80 (3 years postoperatively). Six patients had an excellent score, 14 had a good score, three had a fair score, and one patient had a poor score. Improvements were seen in the range of motion in all the patients when compared with the preoperative period.ConclusionThe management of post-traumatic AVN of the femoral head in young and active patients continues to be a challenge. The results of cementless hip arthroplasties are satisfactory and encouraging in treating this group of patients.