Abstract
Purpose
To identify modifiable factors related to post-operative dislocation and reoperation in patients with osteonecrosis of the femoral head (ONFH) in a large cohort.
Methods
We studied 4995 hip arthroplasties: total hip arthroplasty (THA) was performed in 79% of patients; bipolar hemiarthroplasty (BP), 17%; total resurfacing arthroplasty (tRS), 3%; and hemi-resurfacing arthroplasty (hRS), 1%. A new type of BP (accounting for 49% of BPs) comprised a femoral component with a polished or smooth, small-diameter (approximately 10 mm) neck with a round or oval axial cut surface and no sharp corners.
Results
The infection rate was relatively low (0.56%) even though 58% of cases of ONFH were associated with systemic steroid use, a known risk factor for infection. Post-operative dislocation occurred in 4.3% of cases, with re-operation needed in 3.9%. The dislocation rate was related to surgery type: 5.2% in THA, 0.9% in BP, and 0% in tRS and hRS. Among total arthroplasties with six month or longer follow-up (3670 THAs and 159 tRSs), the risk factors for post-operative dislocation were younger (≤ 40 years) or older (≥ 62 years) age, higher body weight, posterolateral approach, and smaller prosthetic head diameter. Regarding the need for re-operation, higher body weight and surgery type were identified as risk factors.
Conclusions
The relatively high dislocation rate of 5.2% in THA is a cause for concern. The identified risk factors for dislocation should be considered when selecting THA for treatment. Prosthesis survivorship in hRSs was inferior to that in BPs or THAs. Body weight also affected the survivorship of hip arthroplasties.
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Acknowledgements
The authors are grateful to the researchers listed in Table 1 who participated in this study following up the patients with hip arthroplasties and collecting data.
Funding
The principal investigator (NS) of the Japanese Investigation Committee under the auspices of the Ministry of Health Labour and Welfare received a research grant from the Ministry of Health and Welfare of Japan (Research on Measures for Intractable Diseases) and this study was partly supported by this fund.
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We obtained institutional ethical approvals for this study.
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Kobayashi, S., Kubo, T., Iwamoto, Y. et al. Nationwide multicenter follow-up cohort study of hip arthroplasties performed for osteonecrosis of the femoral head. International Orthopaedics (SICOT) 42, 1661–1668 (2018). https://doi.org/10.1007/s00264-018-3980-1
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DOI: https://doi.org/10.1007/s00264-018-3980-1