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OSTEONECROSIS - THA

OSTEONECROSIS - THA. M. E. Cabanela, M.D. Professor of Orthopedic Surgery Mayo Clinic College of Medicine Rochester, Minn. OSTEONECROSIS - ARTHROPLASTY Indication. Femoral head collapse. OSTEONECROSIS - ARTHROPLASTY. Hemiresurfacing Femoral head replacement : monopolar or bipolar

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OSTEONECROSIS - THA

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  1. OSTEONECROSIS - THA M. E. Cabanela, M.D.Professor of Orthopedic SurgeryMayo Clinic College of Medicine Rochester, Minn.

  2. OSTEONECROSIS - ARTHROPLASTYIndication Femoral head collapse

  3. OSTEONECROSIS - ARTHROPLASTY • Hemiresurfacing • Femoral head replacement : monopolar or bipolar • Total resurfacing • Total hip arthroplasty

  4. OSTEONECROSIS - ARTHROPLASTYBipolar Yr No F/U E/G Groin Thigh Revision (yrs) Pain Pain Lachiewitz 88 31 (U/C)4.6 48% 20% 7% Cabanela 90 23 (C) 9.2 59% 12% 8% Cabanela 90 14 (U) 5.3 57% 21% 43% Learmonth 93 38 (C) 4.7 10.5% Takaoka 92 83 (U/C)5.5 85% Hannsen 87 13 (U/C)5.0 23% 23.0% • Cabanela ME: Bipolar vs. Total Hip Arthroplasty for Avascular Necrosis of the femoral head. CORR 261:59-62,1990

  5. 6 yrs PR

  6. OSTEONECROSIS - ARTHROPLASTYBipolar • Abandoned • No advantages over THA • Main reason for failure is groin pain

  7. OSTEONECROSIS-THA Advantages • Most predictable pain relief Disadvantages • Terminal Rx (no comeback)

  8. OSTEONECROSISCemented THA Results Yr No F-up Failure Stauffer 82 10 yrs 50% Salvati 86 28 8 yrs 37% Kantor 96 28 7.7 yrs 12.5% Garino 97 123 6.6 yrs 8%

  9. OSTEONECROSISUncemented THA Results Yr Type No F-up Stem Socket (yrs) failure failure (%) (%) Brinker 94 H-G 81 5 19.7 6.2 Lins 93 PCA 37 5 18.9 2.7 Piston 94 AML 35 7.5 2.9 5.7 D’Antonio 97 HA-Omnifit 53 6 0 15

  10. Are the results of THA for AVN inferior to those of THA for OA?

  11. Ortiguera CJ, Pulliam IT, Cabanela ME: Total hip arthroplasty for osteonecrosis. Matched-pair analysis of 188 hips with long-term follow-up. J Arthroplasty 14:21-28, 1999.

  12. THAOA vs ON • Two matched groups of THA (cemented Charnley) • 94 hips each • Matched for age, sex, surgeon, approach, and prosthesis • 70 m 118 f • 58 yrs (30-79)Follow-up 17.8 yrs (10-25)

  13. THAOA vs ON Results ON 18% Revision rates OA 19% <50 yrs: ON  revision rate (p<.005) Acetabular loosening no different Femoral loosening higher in ON (p<0.05) Complications same except dislocation higher in ON (p<.05)

  14. AVN VS DJDCemented THA Results poorer in AVN Saito S et al: Clin Orth 244:198, 1989 Ritter M et al: Clin Orth 338:94, 1997 Ortiguera C et al: J Arthr 14:21, 1999

  15. AVN VS DJDUncemented THA • No difference in clinical orradiographic results -Xenakis TA et al: CORR 341:62, 1997

  16. AVN VS DJDComplications of THA • Instability statistically greaterin AVN -Ortiguera CJ: J Arthr 14:21, 1999-Parvizi J: MAOA, April 2000

  17. OSTEONECROSIS-THA Technical Considerations • Select implant using same criteria as for other Dx • Do not overream socket • Watch for socket fx • Augment socket fixation with screws • Choose femoral component depending on metaphyseal bone changes from previous surgery

  18. OSTEONECROSIS-THACONCLUSIONS • Final solution • Not a routine THA • At this time ?’s remain about complications and durability • Future of AVN rests in avoiding collapse and thus avoiding THA

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