All patients who had received an Austin Moore hemi-arthroplasty between 6 February 1998 and 14 July 2002 were included in the study. Of the 101 patients, 34 were lost to follow-up, 34 had passed away and one did not give consent for the study. The Physical Performance of Activities of Daily Living (PODL) was evaluated, using a modified version of the functional status index by Jette. The level of social functioning was determined by a questionnaire developed by House . Muscular function was evaluated by a timed ‘carpet run’ of 20 m and measuring the time it took to rise twice from an armless chair. The data were compared to an age-matched control group of 44 volunteers. The 45% complication rate in the study group included four dislocations (12%), two femoral fractures (6%) and three deep infections (9%). The social functioning questionnaire showed an average or above average score in most of the patients, 22 of whom (69%) were satisfied with the results. On the PODL score 19 patients (60%) were above average in dependency. Ten (31%) reported no functional pain and four (10%) reported severe pain. Muscular function tests showed a statistically significant difference between the operated group and the control group, with the mean ‘carpet run’ three times longer. Even though the study showed good results as far as dependency and social functioning was concerned, there was a high complication rate and a low objective functional outcome. We concluded it was an effective procedure for patients who did not have high functional expectations, and that physiological status should play a greater role than chronological age in therapeutic decision-making.
The purpose of our study was to ascertain whether complete debridement and cancellous bone grafting prevents the progression of early (Ficat stages I to III) non-traumatic avascular necrosis of the femoral head. Between 1995 and 2001 15 patients presented at the Pre-toria Academic Hospital with atraumatic avascular necrosis of the femoral head. The necrosis was staged according to the modified Ficat classification based on radiographs and on MRI and/or a bone scintigram: there were five Ficat stage-I, six stage-IIA, two stage-IIB and two stage-III hips. Postoperatively the diagnosis was confirmed histologically in all cases. Using the Harris Hip Score (HHS), patients were clinically evaluated preoperatively and at each follow-up examination. The Ficat classification was also determined at each follow-up. A lateral approach with a trap door procedure was followed by debridement of the necrotic area and autogenous bone grafting. The mean follow-up period was 20 months, with the longest follow-up six years. There was no progression of disease in the five patients with Ficat stage-I hips, and there was a mean HHS improvement of 40 points. The six Ficat stage-IIA and two stage-IIB patients also had no progression of disease and exhibited 53 and 78 point respectively HHS improvements. Both Ficat stage-III patients progressed to total hip arthroplasties after a mean of 17 months. We conclude that debridement and cancellous bone grafting is effective in treating patients with Ficat stage-I to IIB avascular necrosis.
