Patients and Methods

This study included 95 patients (111 hips) with a mean age of 40 years (21 to 64) who underwent TRO for ONFH. The mean follow-up was 18.2 years (3 to 26). Kaplan–Meier survivorship analyses were performed with conversion to total hip arthroplasty (THA) and radiological failure due to secondary collapse of the femoral head or osteoarthritic changes as the endpoint. Multivariate analyses were performed to assess risk factors for each outcome.

Patients and methods

We performed 36 primary cemented THA with acetabular IBG in 33 patients between November 2004 and May 2009. As one patient died due to unrelated disease at 6 months after the surgery, 35 hips of 32 patients were included in this study. The average age at the surgery was 62.4 years, and the average follow-up period was 7.9 years (5–10 years). Diagnoses were osteoarthritis due to acetabular dysplasia in 28 hips (26 patients), Rheumatoid arthritis (RA) in 4 hips (3 patients), rapidly destructive coxopathy (RDC) in 1 hip (1 patient), idiopathic acetabular protrusion in 1 hip (1 patient), and acromegaly in 1 hip (1 patient).

For clinical assessment, the Merle d'Aubigné and Postel hip score was assessed and degree of post-operative improvement was classified according to their method as very great improvement, great improvement, fair improvement, and failure. Perioperative complications were also recorded. Acetabular bone defects were assessed at the surgery and categorized using AAOS acetabular bone defect classification system.

For radiological assessment, anteroposterior radiographs of the bilateral hip joints were analyzed preoperatively and post-operatively. Radiolucent lines (RLL) of more than 2 mm around the acetabular components were assessed using the DeLee and Charnley zone classification. Acetabular component loosening was assessed according to the Hodgkinson et al. classification system, and type 3 (complete demarcation line) and type 4 (migration) were classified as “loosening”.