Uncemented Total Hip Arthroplasty in Patients with a History of Pelvic Irradiation for Prostate Cancer

Abstract

Pelvic irradiation for a malignant tumor may cause osteonecrosis of the acetabulum. The purpose of this study was to evaluate the outcome of uncemented total hip arthroplasty in patients with a history of pelvic irradiation for the treatment of prostate cancer. We performed a retrospective review of the clinical records and radiographs of fifty-eight patients (sixty-six hips) who had had radiation therapy for prostate cancer and had subsequently undergone an elective primary uncemented total hip arthroplasty at our institution. The mean age of the patients at the time of the index operation was seventy-four years. The mean duration of follow-up was 4.8 years (range, two to 7.5 years). At the time of the final follow-up, fifty-one patients (fifty-eight hips) who were still living and had been followed for a minimum of two years had a well-ingrown and functioning replacement. The mean Harris hip score had significantly improved from 47 points preoperatively to 90 points at the time of the final follow-up (p < 0.05). The mean scores on the physical and mental health measures of the Short Form-36 had also improved significantly from 45.1 and 65.3 points, respectively, before the operation to 73.4 and 83.7 points postoperatively (p < 0.05 for both). There was no aseptic loosening of either component in any of the hips. Two hips had revision of the femoral component; one was revised because of a periprosthetic fracture of the femur and the other because of subsidence of the femoral component. Uncemented total hip arthroplasty can be a successful option for the treatment of coxarthrosis in patients with a history of pelvic irradiation for prostate cancer. Osseointegration of uncemented components does not seem to be compromised in these patients in the short term. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.