Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head.

The authors studied 61 patients (78 hips) who had avascular necrosis of the femoral head, seen in followup for an average of 7.2 years (range, 6-9 years) after they had primary cementless porous-coated total hip arthroplasty. This study was undertaken to determine whether cementless porous-coated prostheses have any merit over reported cemented total hip arthroplasty using contemporary techniques. The average age of the patients at the time of surgery was 48 years old (range, 20-73 years). The average preoperative hip score was 45.6 points (range, 28-75 points), which improved to 90.3 points (range, 34-100 points) at the 7.2-year followup examination. Sixteen of 78 arthroplasties failed in the period of followup, for an overall failure rate of 20.5%. Of the failed hips, 11 had femoral component loosening, 4 had femoral and acetabular component loosening, and 1 had excessive wear in the polyethylene liner. Four femoral components and 5 acetabular components were revised. Twenty-one of the 78 hips (27%) had an average of 5.6 mm (range, 3-9 mm) of wear in the polyethylene liner. Sixteen (20.5%) of 78 hips had acetabular and femoral periprosthetic osteolysis, and 22 (28.2%) hips had femoral periprosthetic osteolysis only. The cementless total hip arthroplasty in this series had a higher incidence of aseptic loosening of the femoral component, polyethylene liner wear, and periprosthetic osteolysis than that reported for cemented total hip arthroplasty using contemporary techniques.