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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

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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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References

  1. Liu F, Wang W, Yang L et al (2017) An epidemiological study of etiology and clinical characteristics in patients with nontraumatic osteonecrosis of the femoral head. J Res Med Sci 22:15. https://doi.org/10.4103/1735-1995.200273

    Article  PubMed  PubMed Central  Google Scholar 

  2. Erivan R, Villatte G, Dartus J et al (2019) Progression and projection for hip surgery in France, 2008–2070: epidemiologic study with trend and projection analysis. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2019.07.021

    Article  PubMed  Google Scholar 

  3. Ficat P, Arlet J (1973) Pre-radiologic stage of femur head osteonecrosis: diagnostic and therapeutic possibilities. Rev Chir Orthop Reparatrice Appar Mot 59(Suppl 1):26–38

    Google Scholar 

  4. Colaço HB, Davidson JA, Davenport D et al (2018) Current practice of BHS members in the treatment of osteonecrosis of the femoral head in adults. Hip Int 28:90–95. https://doi.org/10.5301/hipint.5000535

    Article  PubMed  Google Scholar 

  5. Erivan R, Riouach H, Villatte G et al (2020) Hip preserving surgery for avascular hip necrosis: does terminating exposure to known risk factors improve survival? Phys Sportsmed. https://doi.org/10.1080/00913847.2020.1711827

    Article  PubMed  Google Scholar 

  6. Osawa Y, Seki T, Takegami Y et al (2018) Cementless total hip arthroplasty for osteonecrosis and osteoarthritis produce similar results at ten years follow-up when matched for age and gender. Int Orthop 42:1683–1688. https://doi.org/10.1007/s00264-018-3987-7

    Article  PubMed  Google Scholar 

  7. Ancelin D, Reina N, Cavaignac E et al (2016) Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res 102:1029–1034. https://doi.org/10.1016/j.otsr.2016.08.021

    Article  CAS  PubMed  Google Scholar 

  8. Ortiguera CJ, Pulliam IT, Cabanela ME (1999) Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term follow-up. J Arthroplasty 14:21–28

    Article  CAS  Google Scholar 

  9. Issa K, Johnson AJ, Naziri Q et al (2014) Hip osteonecrosis: does prior hip surgery alter outcomes compared to an initial primary total hip arthroplasty? J Arthroplasty 29:162–166. https://doi.org/10.1016/j.arth.2013.04.028

    Article  PubMed  Google Scholar 

  10. Johannson HR, Zywiel MG, Marker DR et al (2011) Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review. Int Orthop 35:465–473. https://doi.org/10.1007/s00264-010-0979-7

    Article  PubMed  Google Scholar 

  11. Nich C, Rampal V, Vandenbussche E, Augereau B (2006) Metal-metal-backed polyethylene cemented hip arthroplasty: mid-term results. Rev Chir Orthop Reparatrice Appar Mot 92:118–124

    Article  CAS  Google Scholar 

  12. Langton DJ, Jameson SS, Joyce TJ et al (2010) Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. J Bone Joint Surg Br 92:38–46. https://doi.org/10.1302/0301-620X.92B1.22770

    Article  CAS  PubMed  Google Scholar 

  13. Drummond J, Tran P, Fary C (2015) Metal-on-metal hip arthroplasty: a review of adverse reactions and patient management. J Funct Biomater 6:486–499. https://doi.org/10.3390/jfb6030486

    Article  PubMed  PubMed Central  Google Scholar 

  14. Merle D’Aubigné R (1990) Numerical classification of the function of the hip. 1970. Rev Chir Orthop Reparatrice Appar Mot 76:371–374

    PubMed  Google Scholar 

  15. Johnston RC, Fitzgerald RH, Harris WH et al (1990) Clinical and radiographic evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Joint Surg Am 72:161–168

    Article  CAS  Google Scholar 

  16. Devane PA, Horne JG, Martin K et al (1997) Three-dimensional polyethylene wear of a press-fit titanium prosthesis. Factors influencing generation of polyethylene debris. J Arthroplasty 12:256–266

    Article  CAS  Google Scholar 

  17. Steinberg ME, Hayken GD, Steinberg DR (1995) A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 77:34–41

    Article  CAS  Google Scholar 

  18. Steinberg DR, Steinberg ME, Garino JP et al (2006) Determining lesion size in osteonecrosis of the femoral head. J Bone Joint Surg Am 88(Suppl 3):27–34. https://doi.org/10.2106/JBJS.F.00896

    Article  PubMed  Google Scholar 

  19. Steinberg ME, Oh SC, Khoury V et al (2018) Lesion size measurement in femoral head necrosis. Int Orthop 42:1585–1591. https://doi.org/10.1007/s00264-018-3912-0

    Article  PubMed  Google Scholar 

  20. Kerboul M, Thomine J, Postel M, Merle d’Aubigné R (1974) The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br 56:291–296

    Article  CAS  Google Scholar 

  21. Koo KH, Kim R (1995) Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Joint Surg Br 77:875–880

    Article  CAS  Google Scholar 

  22. Statistical software & data analysis add-on for Excel | XLSTAT. In: Xlstat, Your data analysis solution. https://www.xlstat.com/en/. Accessed 4 Mar 2019

  23. Ryan SP, Wooster B, Jiranek W et al (2019) Outcomes of conversion total hip arthroplasty from free vascularized fibular grafting. J Arthroplasty 34:88–92. https://doi.org/10.1016/j.arth.2018.09.041

    Article  PubMed  Google Scholar 

  24. Shigemura T, Yamamoto Y, Murata Y et al (2018) Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: a systematic review and meta-analysis. Orthop Traumatol Surg Res 104:1163–1170. https://doi.org/10.1016/j.otsr.2018.06.019

    Article  PubMed  Google Scholar 

  25. Parker MJ, Cawley S (2020) Cemented or uncemented hemiarthroplasty for displaced intracapsular fractures of the hip: a randomized trial of 400 patients. Bone Joint J 102-B:11–16. https://doi.org/10.1302/0301-620X.102B1.BJJ-2019-1041.R1

    Article  PubMed  Google Scholar 

  26. Erivan R, Villatte G, Lecointe T et al (2019) Long-term survival of hybrid total hip arthroplasty with the uncemented CLS cup, cemented Müller cobalt-chromium stem, and 28-mm Metasul™ bearings: retrospective review of 115 hips after a minimum of 17.8 years. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2019.06.019

    Article  PubMed  Google Scholar 

  27. Cooper HJ, Della Valle CJ (2014) Large diameter femoral heads: is bigger always better? Bone Joint J 96-B:23–26. https://doi.org/10.1302/0301-620X.96B11.34342

    Article  CAS  PubMed  Google Scholar 

  28. Suksathien Y, Sueajui J (2018) Mid-term results of short stem total hip arthroplasty in patients with osteonecrosis of the femoral head. Hip Int. https://doi.org/10.1177/1120700018816011

    Article  PubMed  Google Scholar 

  29. Amstutz HC, Le Duff MJ (2018) The mean ten-year results of metal-on-metal hybrid hip resurfacing arthroplasty. Bone Joint J 100-B:1424–1433. https://doi.org/10.1302/0301-620X.100B11.BJJ-2017-1459.R2

    Article  CAS  PubMed  Google Scholar 

  30. Erivan R, Villatte G, Brientini J-M et al (2018) 7-year results of primary total hip arthroplasty with the uncemented Avenir stem. HIP Int. https://doi.org/10.1177/1120700018810211

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. CNRS, SIGMA Clermont, ICCF, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000, Clermont–Ferrand, France

    Roger Erivan, Guillaume Villatte, Stéphane Descamps & Stéphane Boisgard

  2. Université Clermont Auvergne, CHU Clermont-Ferrand, 63003, Clermont–Ferrand, France

    Thomas Caputo & Hicham Riouach

  3. Délégation à la Recherche Clinique et aux Innovations (DRCI) - CHU Clermont-Ferrand, 63000, Clermont–Ferrand, France

    Bruno Perreira

  4. Orthopedic and Trauma Surgery Department, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, BP 69, 63003, Clermont–Ferrand, France

    Roger Erivan

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  1. Roger Erivan
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  2. Thomas Caputo
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  4. Guillaume Villatte
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Correspondence to Roger Erivan.

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RE, TC, HR, GV, BP, SD have no conflict of interest. SB is Zimmer consultant.

Ethical statement

It is a retrospective study of current care that does not require an ethical approval form, but we obtained agreement from all patients.

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Erivan, R., Caputo, T., Riouach, H. et al. Primary total hip replacement in Ficat–Arlet stage 3 and 4 osteonecrosis: a retrospective study at a minimum 12-year follow-up. Eur J Orthop Surg Traumatol 30, 845–850 (2020). https://doi.org/10.1007/s00590-020-02644-z

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  • DOI: https://doi.org/10.1007/s00590-020-02644-z

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