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Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis

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Abstract

Purpose

Osteonecrosis of the femoral head (ONFH) is commonly detected in young patients and most surgeons tend to delay total hip arthroplasty (THA) until the end stage of the disease. We hypothesised that post-operative range of motion (ROM) of the hip as well as baseline ROM at the time of surgery decreases with the disease progression. The purpose of this study was to determine whether patients, who were operated at an advanced stage, have pre- and post-operative hip ROM similar to ROM of patients, who were operated at earlier stages.

Methods

Eight hundred and fifty patients (850 hips) treated with THA for ONFH were classified according to pre-operative stages of Association Research Circulation Osseous (ARCO). Fifty-six patients were operated at stage 2, 458 at stage 3, and 336 at stage 4. Pre-operative and one year post-operative ROM was compared among the stages.

Results

Pre-operative sum of hip ROM decreased with the progression of ARCO stage (P < 0.001) and correlated with the post-operative sum of hip ROM (correlation coefficient 0.661). Although hip ROM improved after THA in all stages, post-operative ROM in patients with lower pre-operative ROM did not improve to the same level as in those with a higher pre-operative ROM (P < 0.001).

Conclusions

The progression of ONFH negatively affected post-operative hip ROM as well as baseline hip ROM at the time of THA. Surgeons should consider a delay of THA negatively affects the hip ROM after the arthroplasty, when they determine the treatment modality for ONFH patients.

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Author information

Author notes

  1. Woo-Lam Jo and Young-Kyun Lee equally contributed as co-first authors.

Authors and Affiliations

  1. Seoul St. Mary’s Hospital, Department of Orthopaedic Surgery, Catholic University, 222, Banpo-daero, Seocho-gu, Seoul, 06591, South Korea

    Woo-Lam Jo

  2. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 13620, South Korea

    Young-Kyun Lee & Kyung-Hoi Koo

  3. Department of Orthopaedic Surgery, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul, 06973, South Korea

    Yong-Chan Ha

  4. Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea

    Tae-Young Kim

Authors
  1. Woo-Lam Jo
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  2. Young-Kyun Lee
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Correspondence to Tae-Young Kim.

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The authors declare that they have no conflict of interest.

Research involving human participants

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived for this study.

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Jo, WL., Lee, YK., Ha, YC. et al. Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis. International Orthopaedics (SICOT) 42, 1599–1603 (2018). https://doi.org/10.1007/s00264-018-3952-5

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  • DOI: https://doi.org/10.1007/s00264-018-3952-5

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