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Primary total hip replacement in Ficat–Arlet stage 3 and 4 osteonecrosis: a retrospective study at a minimum 12-year follow-up

Abstract : Introduction Results of total hip replacement (THR) for aseptic osteonecrosis are controversial and conflicting according to implant type and generation. The present study consisted in a retrospective assessment of implant survival in primary THR for aseptic osteonecrosis, using a cemented stem, standard polyethylene press-fit acetabular component, and metal–metal bearing. The study hypothesis was that THR results are equivalent between aseptic osteonecrosis and osteoarthritis of the hip. Material and method A single-center retrospective study included 54 patients with metal-on-metal THR for femoral head osteonecrosis. The main endpoint was revision surgery for all causes, whether implant related or procedure related; secondary endpoints were complications and progression in clinical scores. Results Mean follow-up was 13.9 ± 1.6 years (range 12.0–17.1 years). Eighteen of the 54 patients (33.3%) died. Implant survival at last follow-up was 93.8% (95% CI, 87.1–100). There were 12 complications (22.2%): 1 intraoperative, 5 (9.3%) immediate postoperative, and 6 (11.1%) long term. Clinical assessment found a significant 43.1 point improvement in mean Harris score (p = 8.4E−33) and a 5.6 point improvement in mean PMA score (p = 2.9E−22). Conclusion Survival in primary THR for aseptic osteonecrosis was good. Follow-up needs to be rigorous to screen for onset of complications. Primary THR is thus justified in Ficat–Arlet stage 3 and 4 aseptic osteonecrosis of the hip. Level of evidence IV.
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https://hal.uca.fr/hal-03145260
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Submitted on : Thursday, February 18, 2021 - 11:17:03 AM
Last modification on : Sunday, June 26, 2022 - 3:04:56 AM

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Roger Erivan, Thomas Caputo, Hicham Riouach, Guillaume Villatte, Bruno Perreira, et al.. Primary total hip replacement in Ficat–Arlet stage 3 and 4 osteonecrosis: a retrospective study at a minimum 12-year follow-up. European Journal of Orthopaedic Surgery & Traumatology, Springer-Verlag, 2020, 30 (5), pp.845-850. ⟨10.1007/s00590-020-02644-z⟩. ⟨hal-03145260⟩

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