Highly Crosslinked Polyethylene Liners in Patients with Osteonecrosis of the Femoral Head in the United States and Europe

Abstract

The treatment of patients with osteonecrosis (ON) of the femoral head has changed over the last 30 years from the concept of saving the femoral head at all costs to the more recent concept of treating symptomatic femoral head collapse, in the setting of ON, with total hip arthroplasty. Approximately 20,000 patients are diagnosed in the United States with ON of the femoral head every year [1] with the average age at presentation being 38 years. Although femoral head core decompression, with or without bone grafting, for the early stages of ON is still performed with reasonable success, it plays no role in the patient with collapse. Free vascularized bone grafting of the femoral head and neck has been shown to have marginally superior results to core decompression in the treatment of pre-collapse lesions [2]; however, results are much better when used for lesions with early collapse, but subsequent THA can be less successful as a result [3]. Proximal femoral redirectional osteotomies are described in the treatment of ON of the femoral head; however, these are technically demanding surgeries with significant associated complications and can make any subsequent THA more difficult [4]. These osteotomies should be reserved for the much younger patient with modest-sized lesions [5].