Purpose: The purpose of this retrospective study was to assess clinical and radiological outcome at ten years follow-up at least in a continuous series of total hip arthroplasties performed in patients with aseptic necrosis of the femoral head.

Material and methods: The series included 122 arthroplasties performed between January 1980 and December 1996 in 96 patients (26 women and 70 men), aged 50.8±13.3 years (range 21–85 years). The underlying cause was essential necrosis in 40.6%, cortocosteroid threapy in 19.8%, chronic alcoholism for 17%, trauma for 12%, and another medical cause for 10%. The Ficat and Arlet classification was grade IV 80 hips, grade III 42 hips. All arthroplasties were performed via the transtrochanteric approach. Cemented Charnley-Kerboull implants were used with a metal-polyethylene couple in all cases. The Merle d’Aubigné score was used to assess functional outcome. Cup wear was measured according to Livermore. Actuarial survival curves were calculated.

Results: Follow-up was greater than ten years for all patients (mean 13±2.6 years, range 10–21 years). At last follow-up 59 patients (75 hips) were living and had not undergone revision and seven patients (seven hips) had undergone revision of the acetabular and/or femoral component. Twenty patients (24 hips) had died and ten patients (16 hips) were lost to follow-up. Revision procedures were performed for periacetabular osteolysis in one hip, infection in one hip, and acetabular loosening in five hips. Three patients experienced luxation or subluxation. The mean preoperative function score was 11 (range 5 – 16) compared with 17 (14–18) at last follow-up (p < 0.05). Clinical outcome was good or excellent in 95% of the patients and fair or poor in 5%. Mean overall cup wear was 0.965 mm (0–5) for non revised hips. Lucent lines were found around eleven acetabular implants and six femoral implants. Cumulative survival, considering revision as failure, was 88.5% at 15 years (95% confidence interval 80.2 – 96.9%).

Discussion and conclusion: The results of this series lead to the conclusion that low-friction total hip arthroplasty is the treatment of choice for advanced stage femoral head necrosis.