Abstract
The mean age of patients with osteonecrosis reported in series in our literature is 38 to 53. Thus, performing a total hip replacement on a patient who would need a procedure to last 40–45 years is a concern. Patients with osteonecrosis of the hip require some type of surgical treatment. Without treatment, a large majority of femoral heads in patients even with Ficat stage I osteonecrosis will collapse or become symptomatic. A common scenario is a patient who first presents to the orthopaedic surgeon with severe arthritis secondary to osteonecrosis in one hip and a normal appearing radiograph on the asymptomatic contralateral side. Performing a total hip on the severe arthritic hip is usually not debated. A MRI will commonly show Ficat stage I osteonecrosis on the asymptomatic contralateral hip. Some method of core decompression is a reasonable choice if it is non-steroid induced, small more medially positioned lesion, but not for other Ficat stage 1 lesions or those with more advanced stages. The problem is convincing the patient to have anything done when they are asymptomatic. Because results with total hip replacement for patients with osteonecrosis of the hip have significantly improved, most patients with a symptomatic hip prefer arthroplasty as treatment. Arthroplasty has become the predominant surgical treatment for osteonecrosis of the hip in the United States. 88% of procedures performed on 6,400 patients with osteonecrosis in 2008 reported in the Nationwide Inpatient Sample Database of the hip were total hip replacements. From 16 years earlier, the number of procedures performed had almost doubled and the percentage use of arthroplasty as the performed treatment had increased by 13%. I expect both numbers will continue to increase.
