Department of Orthopaedic Surgery, Hanyang University Hospital, Haengdang-dong 17, Seongdong-gu, Seoul 133-792, Korea.
Arch Orthop Trauma Surg. 2012 Dec;132(12):1789-96. doi: 10.1007/s00402-012-1613-5. Epub 2012 Sep 15.
The long-term results of a bipolar hemiarthroplasty (BHA) for osteonecrosis (ON) of the femoral head have not been favorable. The causes have been attributed to cup migration and osteolysis or groin pain. The purpose of this study was to analyze the long-term outcomes and the survivorships of bipolar hemiarthroplasty applied to Ficat stage III ON.
Between 1985 and 1993, 49 patients (63 hips) underwent cementless BHA for Ficat stage III ON. Of these 49 patients, 43 patients (55 hips) of mean age 42.2 years were available for follow-up review at a mean duration of 20.3 years post operation. Anteroposterior hip serial (including extreme abduction/adduction) radiographs were used to evaluate osteolysis, migration, cartilage wear rate, and the ratio of outer/inner bearing motion (O/I ratio) at the latest follow-up.
The mean Harris hip score improved to 80.8 points at the latest follow-up. Survivorship at 24 years was 79 and 69 % with revision for any reason and development of acetabular osteolysis as the end point. Groin pain was present in 20 (36.4 %) of the 55 hips, and isolated groin pain was not a reason for revision. The patients had revision surgery performed, which showed that the cartilage wear rate was significantly high, and that the O/I ratio was significantly low (p < 0.05).
Survivorship determined in this study was more favorable than that of previous studies, and exceeded expectation. The BHA for Ficat stage III ON is not reliable option anymore, considering low survival rate and high osteolysis developmental rate.
双极半髋关节置换术（BHA）治疗股骨头坏死（ON）的长期效果并不理想。其原因可归因于杯体迁移、骨溶解或腹股沟疼痛。本研究旨在分析应用于 Ficat Ⅲ期 ON 的双极半髋关节置换术的长期结果和生存率。
1985 年至 1993 年，49 例（63 髋）接受非骨水泥双极半髋关节置换术治疗 Ficat Ⅲ期 ON。在这 49 例患者中，43 例（55 髋）平均年龄 42.2 岁，在术后平均 20.3 年时接受随访。前后位髋关节连续（包括极度外展/内收）X 线片用于评估骨质溶解、迁移、软骨磨损率以及最新随访时外/内轴承运动比（O/I 比）。
末次随访时，平均 Harris 髋关节评分提高至 80.8 分。以任何原因翻修为终点，24 年的生存率为 79%和 69%；以髋臼骨溶解发展为终点，生存率为 79%和 69%。55 髋中有 20 髋（36.4%）存在腹股沟疼痛，孤立性腹股沟疼痛不是翻修的原因。患者接受了翻修手术，结果显示软骨磨损率显著升高，O/I 比显著降低（p<0.05）。
本研究确定的生存率优于以往研究，超出预期。考虑到低生存率和高骨溶解发展率，Ficat Ⅲ期 ON 的 BHA 不再是可靠的选择。
