The purpose of this study is to evaluate short to mid-term clinical and radiological results of metal on metal resurfacing arthroplasty in osteonecrosis of the femoral head (ONFH).

185 hips of 169 patients who underwent metal on metal resurfacing arthroplasty using Birmingham Hip Resurfacing system (Midland Medical Technololgies, Birmingham, UK) between December 1998 and May 2005 were available for this study and all cases were followed up over 3 years. All preoperative diagnoses were ONFH. The extents of necrotic area were analyzed by preoperative MRI scanning. Their mean age at the time of operation was 37.7(range, 16–67) years old and mean period of follow-up was 88(range, 36–113) months. For the clinical assessments, Harris hip scores, UCLA activity scores, pain and ROM were evaluated. Radiological changes such as radiolucencies around the stem, impingement sign, neck narrowing, osteolysis around head and neck junction, loosening of implants, heterotopic ossifications were evaluated in the serial antero-posterior, translateral radiographs of the hip joint.

Preoperative necrotic area was average 42.7(range, 11.5–60) %. Clinically, the average Harris hip score was improved from 85.2 points to 97.1 points at final follow-up. Average UCLA activity scores at the last follow-up was 8.8 and almost of the patients showed high activity and returned to their original job. ROM were very satisfactory. Radiologically, the mean inclination of acetabular component was 48.0°. There were no radiolucent lines around the acetabular components, but 3 cases showed radiolucent lines around the stem of femoral components. Osteolytic lesions were noticed in 10 cases around head-neck junction. Nine hips had impingement signs around the head-neck junction. There was no case which showed evidence of stress shielding. Moderate neck narrowing were shown in 3 cases. There were 6 cases of heterotopic ossification. One hip had a revision surgery to a total hip arthroplasty using big metal ball because of loosening of acetabular component. There was no patient complained limb length discrepancy and no infection, dislocation, thigh pain.

The midterm performance of metal on metal resurfacing arthroplasty in ONFH was very excellent in the aspects of pain relief, ROM of hip joints, rehabilitation and return to preoperative activity and minimization of common complications of conventional total hip arthroplasty. There was no mechanical failure related to the osteonecrosis and we can conclude that performing resurfacing arthorplasty in osteonecrosis less than 50% of extent can be justified. However, performing resurfacing arthroplasties in osteonecrosis of femoral heads needs meticulous surgical techniques and longer learning curve to prevent early failure. Even though our midterm follow-up study revealed excellent results, more long-term follow-up studies are mandatory to determine the survivorship and to verify the problems related to the increased serum metal ion and metal ion toxicity after resurfacing arthroplasty.

The rate of failure of primary THA in patients with osteonecrosis of the femoral head is higher than that in patients who undergo THA because of other diagnoses. We examined the results of cementless THA performed with second-generation in a consecutive series of young patients with osteonecrosis of the femoral head.

Sixty-five consecutive primary THAs with insertion of a femoral stem with a circumferential proximal porous coating (HG Multilock prosthesis) and a cementless acetabular component (Harris-Galante II) were performed in 52 patients with osteonecrosis of the femoral head. These patients were followed prospectively and evaluated at a minimum of 10 years after surgery. Four patients (4 hips) died and three patients (3 hips) were lost to follow-up monitoring. The remaining 45 patients (58 hips) had a mean of 11.1 years (range, 10 to 13.4 years) of clinical and radiographic follow-up.

One stem (1.7%) was revised because of aseptic loosening. Eighteen cups (31%) were revised because of excessive polyethylene wear and osteolysis. One hip (1.7%) underwent revision of both acetabular and femoral component because of excessive polyethylene wear and osteolysis. The mean Harrsi Hip Score improved from 49 points before surgery to 92.8 points after surgery in patients who did not undergo reoperation. Osteolysis around the acetabular component was present in 22 hips (37.9%). Femoral osteolysis was seen in 9 hips (15.5%), and there was no osteolysis below the lesser trochanter in any hip.

Circumferentially porous-coated second-generation femoral prostheses provide excellent fixation in young patients with osteonecrosis of the femoral head. However, a high rate of polyethylene wear and osteolysis in these high-risk patients remains a challenging problem.

We evaluated the effects on infection control and clinical feasibility of a prosthesis with antibiotic-loaded acrylic cement(PROSTALAC) which was designed for treatment of infected total hip arthroplasty.

Thirty patients underwent two-staged exchange arthroplasty using the PROSTALAC for treatment of the infected total hip arthroplasty were analysed from March 1995 to February 2007. For shaping of the stem spacer, cement containing antibiotics were appropriately coated on stem spacer and push and pull movement was carried out within the medullary cavity of proximal femur until cement hardened. Also, for prevent of post surgical dislocation, a specially designed polyethylene liner was used. Postoperatively, antibiotics were administered for at least 6 weeks according to the results of erythrocyte sedimentation rate and C-reactive protein assessment.

Infection cure rated 83.3% (20 cases) and C-reactive protein normalized in an average of 5.6weeks (2wks~26wks) but ESR showed very variable score. Partial weight bearing with crutch was possible after 2 weeks postoperatively and lower-limb shortening averaged to 1.43 cm (0.5~3) with a mean bending range of 63.6 degrees (40~90). There were neither dislocations nor fractures during patient mobilization and 5 cases, especially in old age showed satisfactory results even without second staged revision. Recurred infection after PROSTALAC insertion occurred in 5 cases (15%).

Appropriate techniques of PROSTALAC insertion for stability allows us to adjust the reimplantation timing to the course of infection control.

Introduction: Total hip arthroplasty remains an effective tool for the treatment of patients with end-stage osteonecrosis with collapse of the femoral head, although there is an increased risk for failure. The aim of this study was to assess the clinical and radiographic outcome of the cementless femoral component with a circumferentially porous coated design.

Materials and Methods: Sixty-four total hip arthroplasties in 53 patients with osteonecrosis of the femoral head were available for evaluation after a 5–10 year follow-up period (average, 7 years). The average age at surgery was 48 years (range, 25–66 years). Osteonecrosis etiology was alcohol induced in 31 hips, idiopathic in 21, steroid related in 5, and femoral neck fracture in 7. A cementless Harris-Galante II cup and Multilock cementless femoral stem with circumferentially porous coating in the proximal part were used in all patients.

Results: Average Harris hip scores improved from 51.6 points to 86.6 points. Thigh pain was noticed in 6 hips (9.4%) at the latest follow up. Most of the thigh pain was related to the diffuse osteolysis with stem instability. At the latest follow up, 58 stems (90.6%) displayed stable bony fixation, one (1.6%) fibrous fixation, and five (7.8%) unstable fixation. Twenty-four hips (37.5%) revealed osteolysis mostly in Zones I and VII. Five hips (7.8%) exhibited distal osteolysis. Five hips (7.8%) exhibited mechanical failure of the stem usually associated with the diffuse osteolysis around the stem. The authors have also observed increased polyethylene line wear (annual wear rate = 0.39 mm / year)

Discussion: The increased polyethylene wear may be due to a weaker polyethylene interlocking mechanism of Harris-Galante II cup, a young active age population of osteonecrosis, inadequate polyethylene liner thickness, and frequent sitting cross legged in a non-western population. The midterm results using the circumferentially porous coated stem showed favorable bony ingrowth. Osteolytic lesions were primary limited to proximal Zones I and VII even with increased polyethylene wear particle formation and increased osteolytic lesions in Harris-Galante II cup designs. This may be due to the excellent circumferential osteointegration into the proximal part of the stem.