Total hip arthroplasty in the treatment of severe stages of osteonecrosis of the femoral head and osteoarthritis: results and complications

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Abstract

BACKGROUND: Nowadays total hip arthroplasty (THA) is the method of choice for the treatment of late stages osteonecrosis of the femoral head (OFH) and osteoarthritis (OA) of the hip joint.

OBJECTIVE: To evaluate the efficacy and complication pattern of THA in late stages of OFH and OA.

MATERIALS AND METHODS: The study included 74 patients who underwent primary THA for OA stages III–IV (Kellgren and Lawrence classification) and for OFH stages III–IV (ARCO classification). Group 1 included 34 patients with OFH stages III–IV, and group 2 — 40 patients with OA stages III–IV. The groups were comparable by gender and age. All patients underwent implantation of endoprosthesis components using press-fit fixation with a metal–polyethylene articulation. Treatment results were assessed with regard to the incidence of complications and functional results at 3, 6 months, 1 and 3 years after THA.

RESULTS: In our study, the survival rate of components after THA within 3 years after implantation was 100%. No cases of periprosthetic fracture, periprosthetic infection, and aseptic instability of endoprosthesis components were observed in both groups. The surface inflammation of the postoperative wound was detected in 1 (2.9%) patient in the OFH group and in 1 (2.5%) patient in OA group. Dislocation of the endoprosthesis occurred in 1 patient with OFH; there were no such findings in the OA group. The frequency of peri-implant osteolysis was twice lower (2.5%) in patients with OA compared to OFH group (5.8%). There were no statistically significant differences in the functional results dynamics before and after surgery between the groups (Harris score). The average Harris scale score in patients with OFH was 63 and reached 94 after 3 years; in OA group — 58 and 94, respectively.

CONCLUSION: THA is an alternative method in the treatment of severe hip arthroplasty. Endoprosthetics using a cementless endoprosthesis with a metal–polyethylene articulation demonstrated high efficacy as well as a low number of complications among patients with OFH and OA. We found no significant difference in THA results in terms of survival, postoperative complications, and functional outcome in patients with OFH and OA. Longer postoperative follow-up is advisable, which may allow us to establish some differences in treatment outcomes.

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About the authors

Mikhail A. Panin

City Clinical Hospital N 17; Peoples’ Friendship University of Russia

Author for correspondence.
Email: panin-mihail@yandex.ru
ORCID iD: 0000-0003-4686-7892
SPIN-code: 5834-3500

MD, Cand. Sci. (Med.), Traumatologist-Orthopedist

Russian Federation, Moscow; Moscow

Nikolay V. Zagorodniy

Peoples’ Friendship University of Russia; Priorov National Medical Research Center for Traumatology and Orthopedics

Email: Zagorodniy51@mail.ru
ORCID iD: 0000-0002-6736-9772
SPIN-code: 6889-8186

MD, Dr. Sci. (Med.), Professor, Corresponding member of RAS, Traumatologist-Orthopedist

Russian Federation, Moscow; Moscow

Andrey V. Boiko

Peoples’ Friendship University of Russia

Email: boiko120393@gmail.com
ORCID iD: 0000-0002-7829-2045
SPIN-code: 4543-7879

Graduate Student, Traumatologist-Orthopedist

Russian Federation, Moscow

Armenak S. Petrosyan

City Clinical Hospital N 17

Email: armenak.p@gmail.com
ORCID iD: 0000-0001-8837-0265
SPIN-code: 4040-1407

MD, Cand. Sci. (Med.), Traumatologist-Orthopedist

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. a — radiograph of a 39-year-old patient with grade III osteonecrosis of the femoral head. b — radiograph 30 months after total hip arthroplasty. c — the arrow indicates the zone of osteolysis around the proximal endoprosthesis stem.

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3. Fig. 2. Dynamics of the the hip joint (HHS) functional state in patients with Osteonecrosis of the femoral head and osteoarthritis.

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