Clinical and radiological results of Arthroplasty in avascular necrosis of the femoral head: a study of 88 cases
Dr Hicham EL HYAOUIa, Dr Hakam KHOUMRIa, Dr Haitam ABOUALIa, Prof Abderrahim RAFAOUIa, Prof Abdeljabbar MESSOUDIa, Prof Mohamed RAFAIa, Prof Abdelhak GARCHa, Dr Karima BELHAJb, Dr Aziza NAIT KHCHATb, Dr Naima EL AMRANIb, Prof Fatima LMIDMANIb, Prof Abdellatif EL FATIMIb
a Service de traumatologie-orthopédie, pavillon 32, centre hospitalier universitaire Ibn-Rochd. Casablanca. Maroc, b Service de médecine physique et de réadaptation fonctionnelle. Centre hospitalier universitaire Ibn-Rochd. Casablanca. Maroc
Objectives. The aim of this retrospective study was to evaluate the long-term clinical and radiological results in a continuous series of total hip arthroplasties performed for aseptic necrosis of the femoral head and discuss the therapeutic indications.
Patients and methods. The series included 88 arthroplasties performed between January 1992 and December 2008 in 79 patients with a mean age of 43, 5 years. Functional evaluation was made according to the Postel-Merle d'Aubigné (PMA) score. The preoperative PMA score averaged 8. According to the classification of Ficat and Arlet, 60 hips were classified as stage IV and 28 hips as stage III. The implants used were a total hip prosthesis in 90.9 % of cases; cemented in 55 cases, uncemented in 22 cases and hybrid in 3 cases. Bipolar hemiarthoplasty wase made in 8 patients.
Postoperative analysis and at follow-up was looking for local or systemic complications. Radiographic analysis radiolucent lines around the implants. Finally, the causes of re interventions were studied.
Functional and radiological results were established 5.1 years mean follow.
The mean PMA score was of 15, 8. Radiographic inspection showed that the loosening rate was 3.4% of acetabular implants and 2.27 % of the stems. The rate of periarticular ossification was 9%, of which 1.5% were in stage 3 or 4 of Brooker’s score.
Discussion - Conclusion
Some pathologies (haematological desorders, renal failure) have received considerable therapeutic progress resulting from both an increase in the life of patients and an increase in the prevalence of osteonecrosis of the femoral head. Necrosis may also be the result of the treatments themselves (corticosteroids, immunosuppressants, allografts). The results of arthroplasty in this indication are demonstrative in terms of level of activity and PMA score.
The results of this series conclude that arthroplasty remains the treatment of choice for advanced stages of necrosis.
Keywords : Arthroplasty; Avascular necrosis; Femoral head