Abstract
BackgroundIn young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary. However, only a few studies have evaluated the outcome of short-stem THAs in ONFH. We reviewed the prospectively collected data of a cementless partial neck-retaining short-stem with ceramic-on-ceramic bearings in ONFH patients.MethodsThirty patients (37 hips) younger than 60 years (mean age at surgery, 51.5 years) underwent THA with the NANOS® stem (Smith and Nephew, Marl, Germany) from January 2006 to December 2012. All patients received a 32-mm or 36 mm ceramic femoral head. Harris hip score, WOMAC and UCLA activity score were recorded. Postoperative radiographs were evaluated for bone-implant fixation and osteolysis. Further analysis correlated clinical findings with implants characteristics and patient demographics at mean 5.6 years’ follow-up (range, 3–10 years).ResultsThe clinical and functional results improved significantly (p < 0.001). At latest follow-up, mean HHS, WOMAC, and UCLA activity scores were 90 (range, 71–100), 94 (range, 76–100), and 6.3 (range, 4–10) points, respectively. The diameter of the femoral head did not influence the clinical outcome (p = 0.661). All hips showed bone ingrowth fixation of the acetabular and femoral components. No patients showed osteolysis. No revision for any reason was performed during the study period.ConclusionsThe excellent clinical results and fixation pattern at mean 5.6 years’ follow-up reveal this implant as a reliable option in advanced stage of ONFH either. Further investigations are crucial to determine the long-term durability and to assess whether the association of ceramic-on-ceramic bearings, can be useful to achieve longer survivorship and lower complications rates.Trial registrationRegistry number: ISRCTN 91336248; date of registration: 04/07/2017.
Highlights
In young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary
We reviewed the prospectively collected data of a partial neck-retaining short stem and ceramic-on-ceramic bearings in patients younger than 60 years with progressed Osteonecrosis of the femoral head (ONFH)
From January 2006 to December 2012, a partial neckretaining cementless femoral short-stem was used for 39 THAs in 32 patients 60 years of age or younger, due to osteonecrosis of the femoral head; 7 patients (21.87%) had bilateral THAs
Summary
In young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary. Osteonecrosis of the femoral head (ONFH) is a complex syndrome in which a localized area of bone becomes necrotic, primarily due to an impairment of its blood supply [1]. With regard to non-traumatic ONFH, some of the most common and well-described risk factors include high dose corticosteroid use, chemotherapic and immunosuppressant agents, excessive alcohol consumption, and smoking [2,3,4,5,6,7]. Common jointreplacement treatments include hip resurfacing, total hip arthroplasty (THA) and short stem THA [13,14,15,16,17,18]. High failure and complications rates have been reported for both hemi-resurfacing and total hip resurfacing [10, 13, 19, 20], total hip resurfacing is considered a valuable option only for restricted indications [21, 22]
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