Introduction: The suitability of third generation metal-on-metal hip resurfacing for patients with a primary diagnosis of osteonecrosis (ON) has been debated. The preservation of femoral head bone stock for femoral prosthetic support is essential for long term stability of the implant. We hypothesized that the Kaplan-Meier survival estimates for resurfacing patients with a primary diagnosis of ON would be significantly lower than the survival estimates for resurfacing patients with a primary diagnosis of osteoarthritis (OA).

Methods: One thousand one hundred and forty-eight patients were implanted with a modern hip resurfacing system as part of a United States multi-center investigational device exemption (IDE) study. Of these, 116 subjects had a preoperative diagnosis of ON. A multivariate analysis of variance was performed to identify risk factors for component revision for any reason.

Results: A diagnosis other than OA was found to be one significant risk factor for revision. However, the survival estimates were not significantly different (95.9% and 95.8% at 24 months for OA and ON, respectively, p=0.46) when comparing the OA group to the ON group. Comparing only the Ficat stage III and IV to the OA population also did not show a significant difference in implant survival (95.9% OA and 96.1% ON III/IV at 24 months, p=0.57).

Discussion: Resurfacing arthroplasty for patients with ON appears to be a reasonable alternative using judgments of implant size, patient gender, and size of proximal femoral deficiency. Further characterization will be needed to identify those specific patients with ON for whom resurfacing arthroplasty is not appropriate. For most patients, however, it appears to be a safe and reasonable option.