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German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Total hip arthroplasty in patients with failed fibular grafting for the osteonecrosis of femoral head

Meeting Abstract

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  • presenting/speaker Seung-Hoon Baek - Kyungpook National University Hospital, Daegu, Korea, Republic of (South Korea)
  • Seung-Ki Min - Kyungpook National University Hospital, Daegu, Korea, Republic of (South Korea)
  • Sung-Hyuk Yoon - Kyungpook National University Hospital, Daegu, Korea, Republic of (South Korea)
  • Shin-Yoon Kim - Kyungpook National University Hospital, Daegu, Korea, Republic of (South Korea)

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN13-1073

doi: 10.3205/17dkou028, urn:nbn:de:0183-17dkou0283

Published: October 23, 2017

© 2017 Baek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives: Fibular grating has been used in the treatment for osteonecrosis of the femoral head (ONFH) in an attempt to avoid or delay the need for total hip arthroplasty (THA). However, little has been known regarding the outcome of THAs following failed fibular grafting. The purpose of this study was to evaluate clinical and radiographic results of THAs following failed fibular grafting.

Methods: From March 1982 to Mar 2003, 201 non-vascularized fibular grafting (NVFG) were performed at single institution. Among 53 THAs which were performed following failed NVFG, 2 patients (3 hips) were excluded; one patient (2 hips) was lost before follow-up duration of 2 years and 1 THA was performed within 6 months before enrollment. Thus, the remaining 50 THAs were included in this study. There were 44 males and 6 females and average age at the time of THA was 47.3±12.8 years (range, 22 to 78). The mean time interval between NVFG and THA was 7.6±6.1 years (range, 0.5 to 23.0) and average follow-up period was 12.4±5.7 years (range, 2.2 to 26.1). Cementless cups were used in all patients while cemented stems were implanted in 7 hips (14%). Bearing couples were metal-on-polyethylene in 19 (38%), ceramic-on-ceramic and ceramic-on-polyethylene in each 11 (22%) and metal-on-metal in 9 hips (18%). Clinical outcome included modified Harris hip score (HHS) and radiographic evaluation was performed regarding stem alignment, osteolysis and loosening. Complication included infection, periprosthetic fracture and any reoperation and survivorship free from revision at 10 years was calculated.

Results and Conclusion: HHS was improved from 49.3±11.7 preoperatively to 92.5±7.2 points postoperatively (p<0.01). Osteolysis was shown in acetabulum (10 hips, 20%) and femur (3 hips, 6%) and loosening was demonstrated in 1 cemented stem (2%). Stems aligned within 2 degrees along the axis of femur except 1 hip (2%) with valgus alignment of 2.7 degrees. Eight intraoperative cracks during stem insertion (16%) were treated with cerclage wire and healed without further event. Single episodic dislocation occurred in one hip and treated with manual reduction. One THA (2%) using metal-on-metal articulation was revised due to huge acetabular osteolysis without loosening. The survivorship free from revision at 10 years was 98.0%. In conclusion, THA following failed fibular grafting for ONFH showed excellent outcome with the survivorship of 98.0% at 10 years. However, care should be taken particularly regarding intraoperative crack during stem insertion although it did not affect the clinical or radiographic outcome. Also, longer-term follow-up will be necessary to draw any conclusion regarding the effect of osteolysis on the ultimate outcome.