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Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head

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Abstract

Purpose

Bipolar hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral head (ONFH) is performed at our institution. The purpose of this study was to evaluate the clinical and radiographic findings after BHA for the treatment of steroid -induced ONFH.

Methods

Thirty-seven hips in 27 patients were assessed (seven men, 11 hips; 20 women, 26 hips), average patient age at the time of surgery of 42.6 (range 20–83) years, with steroid-induced ONFH treated with BHA between 1995 and 2005. The mean follow-up duration was approximately ten (range five to15) years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. Kaplan–Meier survivorship was calculated to examine revision arthroplasty failure rate. Radiographic analysis of loosening included radiolucent lines and osteolysis of the acetabulum or femur. Causes of loosening were analysed using multiple logistic regression.

Result

JOA hip score increased from 53 points (preoperative) to 87 points (final follow-up). Survival rates were 96.8 % and 78.6 % at ten and 15 years, respectively. Prosthesis loosening occurred on the acetabular side in five hips (13.5 %). No femoral-component loosening was observed. BHA had poor results in patients with Association Research Circulation Osseous (ARCO) stage IV ONFH and in patients under 40 years of age.

Conclusion

BHA, with strict surgical indications, may be a good option for treating ONFH. Based on these results, total hip arthroplasty is recommended for patients with ARCO stage IV ONFH or for patients under 40 years of age.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1 -15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Mitsutoshi Moriya, Katsufumi Uchiyama, Kensuke Fukushima, Takeaki Yamamoto & Masashi Takaso

  2. Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Naonobu Takahira

  3. Department of Preventive Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Keika Hoshi

  4. Kyusyu Rosai Hospital, 1 -3-1 Kuzuharatakamatsu, Kokuraminami-ku, Kitakyusyu, 800-0296, Japan

    Moritoshi Itoman

Authors
  1. Mitsutoshi Moriya
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  2. Katsufumi Uchiyama
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  3. Naonobu Takahira
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  4. Kensuke Fukushima
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  5. Takeaki Yamamoto
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  6. Keika Hoshi
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  7. Moritoshi Itoman
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  8. Masashi Takaso
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Correspondence to Mitsutoshi Moriya.

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Moriya, M., Uchiyama, K., Takahira, N. et al. Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head. International Orthopaedics (SICOT) 36, 2041–2047 (2012). https://doi.org/10.1007/s00264-012-1612-8

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  • DOI: https://doi.org/10.1007/s00264-012-1612-8

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