Cement less ceramic on ceramic total hip replacement for idiopathic osteonecrosis in young patients. Is it the best solution?
Indian Journal of Orthopaedics Surgery
Management of idiopathic osteonecrosis of the femoral head with arthritis in the young age group is controversial. Total hip replacement is considered the gold standard for management of arthritic hip. However, the longevity of the prosthesis and the number of future revisions are still the main source of concern about total hip replacement in this age group. The use of ceramic on ceramic bearing couples improved the longevity of the prosthesis Patients and methods: In the period from patients
... 22 hips) with idiopathic osteonecrosis of the femoral head were treated by cement less ceramic on ceramic total hip replacement. This study was done at Zagazig university hospitals. The mean age was 29.5 years old. There were 14 males and 4 females. The mean follow up period was 48.4 months. All cases had idiopathic osteonecrosis of the femoral head stage III and IV according to Ficat classification. The functional results were evaluated according to Harris hip score. The radiological results of the femoral and acetabular components following surgery were evaluated according to the criteria of Lins et al and Engh et al., respectively. Results: The mean Harris hip score improved from 39.36 (range 30-56) preoperatively to 89.59 (range 68-96) in the final controls (p<0.001). Fourteen cases had excellent score, four good, three fair, and one patient had poor score. Patients in the zone from good to excellent represented about 80% from total number of cases. Radiolucency was observed around two acetabular components at 36 months follow-up, it was mildly progressive at 60 months follow-up in one case and the other one developed loosening at 48 months follow up for whom, revision was done at 50 months. Two stems were associated with a radiolucent line at 48 months follow-up. Their progression was not sufficient to conclude that there was any loosening at 60 month follow-up. Conclusion: The results of cementless total hip replacement with ceramic on ceramic bearing surfaces are promising for young patients with idiopathic osteonecrosis of the femoral head at 5 years follow up. Longer -term follow up is recommended.