Abstract
Introduction: Recently, a “new paradigm” for the treatment of osteonecrosis (ON) was suggested by Hungerford. Steinberg stage I and II (pre-collapse) ON patients should be treated with conservative measures that do not violate femoral geometry while total hip arthroplasty using newer bearing materials should be considered for Steinberg stage IV (post-collapse) and beyond.
Methods: This strategy has been employed by the senior author since 2000 and results have been favorable.
Results: Twenty-six hips (19 patients) have been treated with core decompression and/or bone grafting when the surface of the femoral head was documented to be intact. Out of these 26 hips treated conservatively, 6 hips required further treatment and 20 (77%) did not. For the treatment of post-collapse disease, twenty-two total hip arthroplasties (19 patients), 1 femoral head resurfacing and 2 hemiarthroplasties (1 patient) have been used.
One of these total hip arthroplasties has been revised for incomplete femoral fixation leading to a 96% survival rate at an average follow-up of 22 months (range: 2 – 74 months). The average Harris Hip Score for these patients at the most recent follow-up was 87.
Discussion: This strategy has proven effective to date, but suggests the need to further refine conservative treatment methods for pre-collapse ON.
The abstracts were prepared by Lynne C. Jones, PhD. and Michael A. Mont, MD. Correspondence should be addressed to Lynne C. Jones, PhD., at Suite 201 Good Samaritan Hospital POB, Loch Raven Blvd., Baltimore, MD 21239 USA. Email: ljones3@jhmi.edu
