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OSTEONECROSIS OF THE FEMORAL HEAD: Modern Results of Total Hip Arthroplasty

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Modern Results of Total Hip Arthroplasty Daniel J. Berry, MD Prof and Chairman Mayo Clinic Rochester, MN OSTEONECROSIS: THA Introduction Advantages of THA: THA is the ... – PowerPoint PPT presentation

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Title: OSTEONECROSIS OF THE FEMORAL HEAD: Modern Results of Total Hip Arthroplasty


1
OSTEONECROSIS OF THE FEMORAL HEAD Modern Results
of Total Hip Arthroplasty
  • Daniel J. Berry, MD
  • Prof and Chairman
  • Mayo Clinic
  • Rochester, MN

2
OSTEONECROSIS THA Introduction
  • Advantages of THA
  • THA is the one form of treatment for
    osteonecrosis with an extremely high likelihood
    of excellent pain relief and good function

3
OSTEONECROSIS THA Results
  • What are the results of THA in the osteonecrosis
    patient population?

4
OSTEONECROSIS THA Results
  • Pain Relief and Function
  • Good
  • Similar pain relief and function to THA for
    other diagnoses

5
OSTEONECROSIS THA Results
  • Pain Relief and Function
  • THA provides more complete/ reliable pain relief
    than hemiarthroplasty or head sparing procedures

Ito et al, CORR 2000 Cabanela, CORR 1990
6
OSTEONECROSIS THA Results
  • THA Durability in osteonecrosis
  • The most controversial topic when discussing THA
    for osteonecrosis

7
OSTEONECROSIS THA Results
  • Difficult to disentangle the fact that most
    osteonecrosis cohorts have high frequency of
    demographic factors and underlying diagnoses that
    put them at risk for implant loosening and wear

8
OSTEONECROSIS THA Results
  • Osteonecrosis patients frequently young and
    active
  • Osteonecrosis includes very high activity
    subgroups e.g. post-traumatic

9
OSTEONECROSIS THA Results
  • Durability Literature
  • One body of literature THA for osteonecrosis
    less durable (loosening/lysis) than THA for
    osteoarthritis
  • Another body of literature little difference in
    durability between THA for osteonecrosis and
    other diagnoses

Ortiguera et al, J Arthrop, 1999 Sarmiento et
al, JBJS(A), 1990 Chiu et al, J Arthrop,
1997 Mont, Hungerford, JBJS(A) 1995 Xenakis et
al, CORR, 1997
10
THA FOR OSTEONECROSIS Uncemented THA
  • These are historical results
  • What are the results with more modern techniques?

11
THA FOR OSTEONECROSIS New Mayo Series
  • 98 uncemented THA
  • 1991-2000
  • 60 male, 38 female
  • Mean age 37 years
  • Mean F/U 6 yrs

Guyen, Cabanela, Berry, 2005
12
THA FOR OSTEONECROSIS New Mayo Series
  • All treated with uncemented HA coated tapered
    stem
  • 28 mm head on conventional PE

13
THA FOR OSTEONECROSIS New Mayo Series
  • Re-operations for aseptic femoral or acetabular
    loosening
  • 0/98 0

14
THA FOR OSTEONECROSIS New Mayo Series
  • Re-operations for bearing wear/osteolysis
  • 8/98 8
  • all had conventional PE bearing

15
OSTEONECROSIS THA Results
  • Literature comparison
  • Good results with other successful uncemented
    designs
  • - extensively porous coated femoral implants
  • - successful tapered uncemented stems

Xenakis et al, CORR 1997 Piston et al,
JBJS(A) 1994 DAntonio et al, CORR 1997
16
THA FOR OSTEONECROSIS Lessons Learned
  • Modern uncemented THA is outperforming historical
    results of cemented THA osteonecrosis patients
  • The fixation results are comparable to uncemented
    THA for other diagnoses

17
THA FOR OSTEONECROSIS Lessons Learned
  • Wear and osteolysis rates in this young patient
    group are unacceptable with conventional PE
    bearing surface
  • Alternative bearings (ceramic, metal, crosslinked
    PE) are justified

18
THA FOR OSTEONECROSIS Dislocation Risk
  • Are osteonecrosis patients at higher risk for
    dislocation?

19
LONG TERM DISLOCATION RISK Materials and Methods
  • All primary Charnley THA performed at Mayo Clinic
    1969-1984
  • 6623 hips

JBJS (A), Jan 2004
20
OSTEONECROSIS THA Complications
  • Dislocation risk is elevated in AVN population

21
LONG TERM DISLOCATION RISK Results
  • Risk of Dislocation (Compared to Osteoarthritis)
  • Factor Relative Risk (CI)
  • DxOsteonecrosis 1.9 (1.1-3.2)

plt0.01
22
OSTEONECROSIS THA Complications
  • Literature Dislocation rate also high in other
    series
  • compliance problems in subgroups of patients
    (EtOH)
  • less capsular hypertrophy in osteonecrosis than
    osteoarthritis

23
THA FOR OSTEONECROSIS Lessons Learned
  • Instability risk elevated in osteonecrosis
  • Efforts to minimize instability justified
  • anterior approaches or
  • posterior approach with capsular repair
  • larger head size ( 32 mm)
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