Osteonecrosis of the femoral head (ONFH) is a debilitating condition. Vascularized iliac bone graft (VIBG) is a joint-preserving surgery to improve blood supply to the avascular portion of the femoral head which may delay secondary osteoarthritis and total hip arthroplasty (THA). However, whether VIBG will affect the subsequent THA survivorship and outcomes are still uncertain.

Implant survivorship and clinical outcomes were compared between 27 patients who had undergone prior VIBG and 242 patients who had only undergone THA for ONFH. Baseline characteristics and the postoperative Harris Hip Score (HHS) were also recorded and compared between the two groups. Implant survivorship was determined using Kaplan-Meier survival analysis.

The overall implant survival for all patients who had a primary diagnosis of ONFH and eventually underwent THA was 92.9%. There was no significant difference in the implant survivorship between the group who directly received THA (survivorship of 93%) and the group which failed VIBG and was subsequently converted to THA (survivorship of 91.9%) (p = 0.71). In addition, higher THA revision rates were associated with smokers and drinkers.

VIBG may be a reasonable option as a “buy-time” procedure for ONFH. Even if conversion to THA is eventually required, patients may be reassured that the overall survivorship and clinical outcomes may not be compromised. Patients are recommended to give up smoking and binge drinking prior to THA to increase implant survival rate.

• Arthroplasty
• Hip
• Osteonecrosis of the femoral head
• Survivorship
• Vascular iliac bone graft

Hip resurfacing arthroplasty (HRA) may be a suitable option for treating osteonecrosis of the femoral head (ONFH). However, concerns regarding the extent of osteonecrosis, amount of defect under the prosthesis, and implant-related complications remain. This study aimed to report implant-specific outcomes and risk factors for failure of HRA in ONFH.

A total of 202 HRAs (166 patients) performed by a single surgeon were investigated. The stage, size, and location of ONFH were evaluated using preoperative radiographs and magnetic resonance images. Clinical, radiographic results, and serum metal concentrations of articular surface replacement (ASR) and non-ASR devices were compared. Logistic regression analysis was performed to identify the contributors of failures. The mean follow-up duration was 10.6 years.

Twenty-six hips (12.9%) were operated with Birmingham Hip Resurfacing (BHR), 99 (49.0%) with ASR, and 77 (38.1%) with Conserve Plus. The mean Harris Hip Score improved from 52.1 to 93.2 at the final follow-up (P < 0.001). Revision-free survivorships of non-ASR and ASR implants were 99.0% and 82.4%, respectively (P < 0.001). In multivariate analysis, the use of ASR prosthesis, greater combined necrotic angle, and smaller head size were associated with revision surgery. A large combined necrotic angle was the only independent risk factor for mechanical failure at the femoral side (P = 0.029).

HRA for ONFH using BHR and Conserve Plus implants demonstrated favourable clinical outcomes with high revision-free survival rates at 10 years. However, care should be taken for large necrotic lesions that can lead to femoral neck fracture or aseptic femoral loosening.

This study suggests HRA performed for appropriately selected patients with ONFH can show excellent long-term clinical results. Therefore, HRA should remain as one of the treatment options for ONFH, and further development of HRA implants should be continued.

• Hip resurfacing arthroplasty
• Implant-specific outcome
• Mechanical failure
• Osteonecrosis of the femoral head
• Risk factors

• EBRA
• Migration
• Optimys
• Osteonecrosis of the femoral head
• Short stem arthroplasty
• Total hip arthroplasty

• Corrosion
• THA
• Tribology
• Wear

• Coxa
• Coxarthrosis
• Joint replacement
• Osteoarthrosis
• Young adult

Avascular necrosis of the hip is a common debilitating disease during the fourth and fifth decades of life. This study attempted to evaluate quality of life in patients with avascular necrosis of the hip joint before and after surgery.

In this study, 40 patients with avascular necrosis of the hip who underwent total hip arthroplasty, bipolar surgery, or cord compression were examined during 2006–2013. Harris Hip Score was used to assess the hip joint function and quality of life before and after surgery. The mean scores and standard deviation were used to describe data for quantitative variables, while frequency percentage was used to describe qualitative variables. Data were analyzed through SPSS v.19 and paired t-test. p < 0.05 was considered significant.

This study involved 40 subjects with a mean age of 32 ± 7.38 years, ranging from 21 to 45 years old. The mean Harris Hip Score for patients before and after surgery were 20.36 and 96.15, respectively, showing a statistically significant difference (p < 0.001). The average patient activity scores before and after surgery (8.9 and 44.2, respectively), non-deformity (1.6 and 3.9), and movement (3.6 and 4.9) indicated significant differences (p < 0.001). Furthermore, 80% of patients felt no hip joint pain six months after surgery, while 92.5% patients did not use any assistive device to walk.

The results of this study demonstrated that surgery substantially contributed to relieving pain and improving hip function in patients with osteonecrosis of the hip joint in the short term.

• Arthroplasty, replacement, hip
• Femur head necrosis
• Quality of life

• Classification systems
• Decision-making challenge
• Osteonecrosis of the femoral head
• Total hip arthroplasty

• Hip arthroplasty
• Hip resurfacing
• Metal-on-metal
• Younger patients

• Adolescent
• Adult
• Age Factors
• Aged
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/instrumentation
• Arthroplasty, Replacement, Hip/methods
• Body Mass Index
• Child
• Female
• Hip Joint/diagnostic imaging
• Hip Prosthesis/adverse effects
• Humans
• Kaplan-Meier Estimate
• Male
• Metal-on-Metal Joint Prostheses/adverse effects
• Metals/blood
• Middle Aged
• Prosthesis Design
• Prosthesis Failure
• Radiography
• Reoperation/statistics & numerical data
• Retrospective Studies
• Risk Factors
• Sex Factors
• Young Adult

Non-traumatic osteonecrosis (ON) of the femoral head is a common disease affecting a young population as the peak age of diagnosis is in the 40 s. The natural history of non-traumatic ON leads to a collapse of the femoral head requiring prosthetic replacement in a 60% of cases. Although trabecular bone involvement in the collapse is suspected, the underlying modifications induced at a molecular level have not been explored in humans. Here, we examine changes in the molecular composition and structure of bone as evaluated by Raman spectroscopy in human end-stage ON. Comparing samples from femoral heads harvested from 11 patients and 11 cadaveric controls, we show that the mineral and organic chemical composition of trabecular bone in ON is not modified apart from age-related differences. We also show that the molecular composition in the necrotic part of the femoral head is not different from the composition of the remaining ‘healthy’ trabecular bone of the femoral head. These findings support that quality of trabecular bone is not modified during ON despite extensive bone marrow necrosis and osteocyte death observed even in the ‘healthy’ zones on histological examination.

Surgical treatment for late stage (post-collapse) osteonecrosis of the femoral head is controversial. In these situations, the outcome of joint preservation procedures is poor. There are several arthroplasty options for late-stage disease. The clinical outcomes of hemiarthroplasty and hemiresurfacing are unpredictable because of progressive acetabular cartilage degeneration. Total hip resurfacing may be associated with further vascular insult to the femoral head and early failure of the implant. Total hip replacement with metal-on-conventional polyethylene bearing surfaces has been the gold standard, but implant survivorship is limited in young active patients due to wear and osteolysis. Newer alternative bearing surfaces may have improved wear characteristics, but their durability must be confirmed in longer-term studies.

• advanced osteonecrosis
• complications
• hip arthroplasty
• implant options
• outcomes

• AVN
• Atraumatic avascular necrosis
• Bisphosphonate
• Bone grafting
• Bone transplant
• Core decompression
• Diagnosis
• Ilomedin
• Total hip arthroplasty
• Total hip replacement

Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis.

Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV.

Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul’s method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation.

The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score – UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed.

Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.

• Femoral head
• Femur head
• acetabular reaming
• arthroplasty
• avascular necrosis
• avascular necrosis of bone
• bipolar hip arthroplasty
• femoral head prosthesis
• hip

Osteonecrosis or avascular osteonecrosis (AVN) of the femoral head is a devastating multifactorial disease that affects 20 000 persons each year in the United States. The purpose of this systematic review was to determine the efficacy and safety of alendronate for adult AVN during short- and long-term follow-up. Electronic databases were searched for randomized or nonrandomized clinical trials, cohort, case-control studies, and series of cases in which alendronate was used for treatment of adult AVN of the femoral head. Relevant articles with adequate data on reduction of pain, improvement of articular function, slowing of bone collapse progression, or need for total hip arthroplasty (THA) were included after applying inclusion and exclusion criteria. Eight articles involving 788 hips with evidence level 1b to 3b were included in this systematic review. Most studies suggested a positive short-term efficacy of alendronate treatment in reducing pain, improving articular function, slowing of bone collapse progression, and delaying the need for THA for adult AVN patients. The favorable long-term results were also presented in those treated patients after 10-year follow-up. In addition, there were no severe adverse effects associated with alendronate treatment observed during short- and long-term follow-up, and most of the included studies suggested use of alendronate in early AVN with small necrotic lesion to achieve better outcomes. The findings support consideration of alendronate use for adult AVN, particularly with early stage and small necrotic size. The lack of large-scale, randomized, and double-blind studies justifies new studies to demonstrate the detailed indication and the optimized strategy of alendronate treatment. Level of evidence: Level 3a.

Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.

• Osteonecrosis
• Femoral neck fracture
• Young patient
• Capsulotomy
• Surgical timing

Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head.

• Arthroplasty
• Hip joint
• Osteonecrosis of the femoral head

• avascular necrosis
• hip preserving surgery
• implant survivorship
• osteonecrosis
• risk factors
• total hip arthroplasty

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip
• Female
• Femur Head Necrosis/surgery
• Hip Joint/surgery
• Humans
• Male
• Middle Aged
• Osteonecrosis/surgery
• Prosthesis Failure
• Reoperation
• Treatment Outcome
• Young Adult

• ankylosing spondylitis
• femoral loosening
• femoral-neck fracture
• hip resurfacing
• osteonecrosis

• Harris hip scores
• clinical outcomes
• implant survivorship
• sickle cell hemoglobinopathy
• total hip arthroplasty

• Harris hip score
• clinical outcomes
• implant survivorship
• systemic lupus erythematosus
• total hip arthroplasty

• Adult
• Arthroplasty, Replacement, Hip/methods
• Disease Progression
• Female
• Femur Head/pathology
• Femur Head Necrosis/complications
• Femur Head Necrosis/diagnosis
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Hip Joint/pathology
• Hip Joint/surgery
• Humans
• Magnetic Resonance Imaging
• Male
• Metal-on-Metal Joint Prostheses
• Middle Aged
• Prosthesis Design
• Prosthesis Failure/etiology
• Retrospective Studies
• Severity of Illness Index
• Survival Rate
• Young Adult

• Adult
• Arthroplasty, Replacement, Hip/methods
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Osteoarthritis, Hip/surgery
• Retrospective Studies
• Time Factors
• Young Adult

• Adult
• Arthroplasty, Replacement, Hip/methods
• Female
• Femur Head Necrosis/diagnostic imaging
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Hip/diagnostic imaging
• Hip/surgery
• Hip Prosthesis
• Humans
• Male
• Middle Aged
• Osteonecrosis/diagnostic imaging
• Osteonecrosis/surgery
• Prosthesis Design
• Radiography
• Retrospective Studies
• Treatment Outcome

• total hip arthroplasty
• osteonecrosis
• metal-on-metal
• resurfacing

• Adult
• Arthroplasty, Replacement, Hip/methods
• Female
• Hip Prosthesis
• Humans
• Male
• Metals
• Middle Aged
• Osteoarthritis/diagnostic imaging
• Osteoarthritis/surgery
• Osteonecrosis/diagnostic imaging
• Osteonecrosis/surgery
• Radiography
• Time Factors
• Treatment Outcome

• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Bone Nails/adverse effects
• Cadaver
• Cementation/methods
• Female
• Femoral Fractures/etiology
• Femoral Fractures/physiopathology
• Femoral Fractures/prevention & control
• Hip Prosthesis/adverse effects
• Humans
• Male
• Prosthesis Design
• Prosthesis Failure
• Treatment Outcome

• bone marrow mesenchymal stem cell
• femoral head necrosis
• migration
• safety

The purpose of this study was to evaluate whether compliance and rehabilitative efforts were predictors of early clinical outcome of total hip resurfacing arthroplasty.

A cross-sectional survey was utilized to collect information from 147 resurfacing patients, who were operated on by a single surgeon, regarding their level of commitment to rehabilitation following surgery. Patients were followed for a mean of 52 months (range, 24 to 90 months). Clinical outcomes and functional capabilities were assessed utilizing the Harris hip objective rating system, the SF-12 Health Survey, and an eleven-point satisfaction score. A linear regression analysis was used to determine whether there was any correlation between the rehabilitation commitment scores and any of the outcome measures, and a multivariate regression model was used to control for potentially confounding factors.

Overall, an increased level of commitment to rehabilitation was positively correlated with each of the following outcome measures: SF-12 Mental Component Score, SF-12 Physical Component Score, Harris Hip score, and satisfaction scores. These correlations remained statistically significant in the multivariate regression model.

Patients who were more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.

• Adult
• Aged
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Australia
• Female
• Hip Prosthesis
• Humans
• Male
• Middle Aged
• Osteoarthritis, Hip/surgery
• Prosthesis Design
• Prosthesis Failure
• Registries
• Reoperation
• Risk Factors
• Sex Factors
• Treatment Outcome