Need For Total Hip Replacement Research Articles

Non-traumatic Avascular Necrosis of the Femoral Head

Avascular necrosis of the femoral head is a debilitating disease that leads to destruction of tho hip joint in patients who are in the third, fourth, or fifth decade of life. The total societal cost is so high because these patients are generally young, hold jobs, and have a considerable life expectancy. Therefore, we have to delay or eliminate the need for total hip replacement as possible as we can. The purpose of this review is to provide a current perspective of avascular necrosis of the femoral head.

Long-term results of core decompression for ischaemic necrosis of the femoral head

We have studied the long-term results of core decompression as the sole treatment for Ficat stages I, II and III ischaemic necrosis of 128 femoral heads in 90 patients. The 5-, 10- and 15-year survival rates for the three stages were respectively: stage I 100%, 96% and 90%; stage II 85%, 74% and 66%; and stage III 58%, 35% and 23%. At a mean follow-up of 11 years (4.5 to 19), 55 hips had failed (43%). No further surgery had been needed for 88% of stage-I, 72% of stage-II and 26% of stage-III hips; but despite the generally satisfactory clinical results, 56% of the hips had progressed radiographically by at least one Ficat stage. Complications of the core procedure included four fractures, all from postoperative falls, and one head perforation due to technical error. We conclude that core decompression delays the need for total hip replacement in young patients with ischaemic necrosis.

CHIARI OSTEOTOMY IN THE ADULT: A LONG-TERM FOLLOW-UP STUDY

For almost 20 years the Chiari pelvic displacement osteotomy has been used as a method of providing cover to the femoral head in cases of acetabular dysplasia. The osteotomy is one of a number of procedures that have been used in an attempt to prevent the early development of secondary osteo-arthritis and the need for total hip replacement. More recently, the operation has been undertaken in cases where there is already some arthritic change. This long-term review of 18 Chiari operations shows that the procedure was successful in cases of acetabular dysplasia where there was minimal subluxation of the femoral head (i.e. with Shenton's line still intact). In more advanced cases where there was significant subluxation (i.e. with Shenton's line broken by more than 1 mm) and even early arthritic changes, the results were poor. It is concluded that the operation may be of value as an almost 'prophylactic' procedure but that it is of no value as a so-called 'salvage' procedure.

Avascular necrosis of the femoral head presenting as trochanteric bursitis.

Five patients are described with avascular necrosis of the femoral head who presented with ipsilateral trochanteric bursitis, in the absence of clearcut hip joint disease. Avascular necrosis was indicated by magnetic resonance imaging. It is suggested that clinical trochanteric bursitis, especially when refractory to local corticosteroid treatment, may be the initial sign of hip disease. In the patient with risk factor(s) for avascular necrosis that diagnosis should be considered and evaluated with appropriate studies, such as magnetic resonance imaging, to prevent weight bearing at an early stage and permit possible surgical decompression in the hope of postponing or obviating the need for total hip replacement.

Total hip replacements in the National Health Service: is need being met?

The extent to which the need for total hip replacement during the early 1980s was being met by the NHS was assessed by examining patterns of utilization during the period 1978 to 1985 in and by residents of North West Thames region. During this period the number of operations performed on residents in NHS hospitals increased by 38 per cent. Within the private sector the number of total hip replacements performed on residents increased from 220 in 1981 to 720 in 1986. The amount of interdistrict variation in the rate of surgery declined as orthopaedic services became more widely available. The proportion of patients waiting more than one year declined from 14 to 4 per cent, suggesting an increasing ability for health services to meet need. Overall these findings suggest that despite improvements in provision during the early 1980s, significant unmet need still existed in 1985.

Incidence of hip involvement and need for total hip replacement in rheumatoid arthritis. An eight-year follow-up study.

In an 8-year follow-up of a prospective study of recent arthritis, 103 patients were found to have erosive and 97% seropositive rheumatoid arthritis. A 20% incidence of hip joint involvement was observed among them. Moderate radiological changes could be seen in 10%, severe destruction (Larsen 4 or 5) in 3%, and acetabular protrusion in 1% of the patients. It was estimated that the minimum annual need of total hip replacement in rheumatoid arthritis in Finland would be 470. This is about 100 per million in the overall population. At the end of the follow-up the Larsen X-ray index was highly significantly (p less than 0.001), ESR significantly (p less than 0.005), and CRP clearly (p less than 0.03) higher in the 13 patients with radiologically confirmed hip changes than in the 90 without them. Thus their hip destruction is attributable to a more severe disease condition and not to the glucocorticoids administered. Furthermore, HLA-B27 was positive in 69% of the above-mentioned 13 patients compared with 27% of the rest, and this difference (p less than 0.005) may also explain the poor prognosis for true rheumatoid arthritis patients.