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Lance S. Estrada, MD, K. David
Moore, MD, John M. Cuckler, MD
Introduction: Advanced osteonecrosis
of the hip in active patients under age 40 is a difficult
problem for the orthopaedic surgeon. There is a general reluctance
to perform total hip replacement (THR) in this younger population
and many of these patients do not alternatives such as a hip
fusion. Femoral head resurfacing (FHR) may provide a "bridging"
procedure that relieves pain and preserves bone stock for
future THR.
Methods: Forty-seven hips in
forty-three patients with Stage III femoral osteonecrosis
were treated with prosthetic resurfacing of the femoral head.
Average age was 38 years. Average weight was 170 lbs. and
50% had bilateral disease. Patients were followed an average
of 3.5 years (range, 2-4 yrs).
Results: The average pre-operative
Harris Hip Score in this series was 53, while the average
post-operative score was 80. At an average of 3.5 years of
follow-up, Harris Hip Scores have declined from the average
of 80 post-operatively to 68 at last follow-up. There have
been 12 failures. Conversion to THR has been straight forward,
with excellent bone stock preservation. Of note, groin pain
requiring anti-inflammatory medication is reported by 60%
in the series.
Conclusions: Postoperatively,
FHR is associated with a high rate of groin pain that is underestimated
by the Harris Hip Score. Also, FHR has a 25% failure rate
at an average of 3.5 yrs of follow-up. Despite these findings,
the authors believe this procedure still may be an acceptable
treatment for Stage III cases of osteonecrosis of the femoral
head in young, active patients, but patients should be educated
in regards to the high failure rate and the "time-buying"
nature of the procedure. Analysis of demographics of the patients
who failed suggests that relative contra-indications may include
age over 40, weight greater than 200 lbs, or infarcts that
subtend the majority of the femoral head (>60%).
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