Oğuz CEBESOY, Bülent ERDEMLİ, Kamil Çağrı KÖSE, MEHMET BAHADDİN GÜZEL, İlker ÇETİN

Kalça osteonekrozunda total kalça artroplastisinin orta dönem sonuçları

Amaç: Femur başı osteonekrozunda total kalça artroplastisinin (TKA) orta dönem sonuçları değerlendirildi. Çalışma planı: Osteonekroz tanısıyla TKA uygulanan 59 hastanın (23 kadın, 36 erkek; ort. yaş 45.6; dağılım 24-66) 72 kalçası incelendi. Osteonekroz 11 kalçada (%15.3) kollum femoriste kırığa bağlı gelişirken, 23 kalçada (%31.9) steroid nedenli idi. Otuz sekiz kalça (%52.8) ise idiyopatik olarak değerlendirildi. Klinik değerlendirmede D’Aubigne-Postel’in ameliyat sonrası fonksiyonel kalça skoru kullanıldı. Radyografik değerlendirmede, kemik-implant ilişkisi femur için Gruen’in yedi bölgesi, asetabulum için Charnley’in üç bölgesi kullanıldı. Ortalama takip süresi 4.1 yıl (dağılım 2-7 yıl) idi. Sonuçlar: Takip sonunda D’Aubigne-Postel kalça skoru ortalaması 11.8 (dağılım 7-16) bulundu. Tüm kalçalarda klinik sonuç iyi veya mükemmel idi. Çimentosuz ve hibrid sistemler arasında kalça skoru açısından anlamlı fark görülmezken (p>0.05), press-fit vidalı sistemin ekspansiyon kapa göre daha iyi olduğu görüldü (p0.05). Ancak, ameliyatta veya sonrasında komplikasyon gelişen kalçalarda klinik skor daha düşüktü (p

Anahtar Kelimeler:

Osteonekroz, Artroplasti, replasman, kalça, Femur başı nekrozu, Kalça eklemi, Kalça protezi

Midterm results of total hip replacement in osteonecrosis of the hip joint

Objectives: We evaluated the midterm results of total hip arthroplasty (THA) for femoral neck osteonecrosis. Methods: The study included 59 patients (23 females, 36 males; mean age 45.6 years; range 24 to 66 years) who underwent THA in 72 hips. Osteonecrosis was secondary to fracture in the femoral neck in 11 hips (15.3%), was associated with steroid use in 23 hips (31.9%), and was idiopathic in 38 hips (52.8%). Functional evaluations were made with the hip scoring system of D’Aubigne and Postel. Bone-implant relations were assessed radiographically using the Gruen’s seven zones in the femur and Charnley’s three zones in the acetabulum. The mean follow-up was 4.1 years (range 2 to 7 years). Results: The mean D’Aubigne-Postel hip score was 11.8 (range 7 to 16), with good or excellent results in all hips. While no significant difference was found between cementless and hybrid systems (p>0.05), the mean hip score was significantly higher with press-fit acetabular systems compared to expansion cups (p<0.001). The effects of the following were found insignificant on the clinical outcome (p>0.05): etiology, metalon- metal or metal-on-polyethylene surfaces, and development of stress shielding in the proximal femur or of varus-valgus angulation in the femoral stem. However, the results were significantly less favorable in cases in which complications arose (p<0.001). Intraoperative complications were fissure in five patients and isolated trochanteric fracture in five patients, all of which occurred in cementless THA. Heterotopic ossification was seen in six hips. At the end of 6.5 years, mild polyethylene wear was detected in eight hips, two of which also had focal osteolysis in Gruen zone 1. Conclusion: Thanks to improvements in implant technology and surgical techniques, the results of both cementless and hybrid systems are satisfactory in hip osteonecrosis, regardless of the etiology.

Keywords:

Osteonecrosis, Arthroplasty, Replacement, Hip, Femur Head Necrosis, Hip Joint, Hip Prosthesis,

PDF

___

1. Chang CC, Greenspan A, Gershwin ME. Osteonecrosis: current perspectives on pathogenesis and treatment. Semin Arthritis Rheum 1993;23:47-69.
2. Dinulescu I. Aseptic necrosis of femoral head and its treatment. In: Casteleyn PP, Duparc J, editors. EFORT. European Instructional Course Lectures. Vol. 2, London: British Editorial Society of Bone and Joint Surgery; 1995. p. 9-18.
3. Babis GC, Soucacos PN. Effectiveness of total hip arthroplasty in the management of hip osteonecrosis. Orthop Clin North Am 2004;35:359-64.
4. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg [Br] 1985;67:3-9.
5. Shetty AA, Slack R, Tindall A, James KD, Rand C. Results of a hydroxyapatite-coated (Furlong) total hip replacement: a 13- to 15-year follow-up. J Bone Joint Surg [Br] 2005; 87:1050-4.
6. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 1979;(141):17-27.
7. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976;(121):20-32.
8. Ito H, Matsuno T, Kaneda K. Bipolar hemiarthroplasty for osteonecrosis of the femoral head. A 7- to 18-year follow-up. Clin Orthop Relat Res 2000;(374):201-11.
9. Cabanela ME. Bipolar versus total hip arthroplasty for avascular necrosis of the femoral head. A comparison. Clin Orthop Relat Res 1990;(261):59-62.
10. Steinberg ME, Corces A, Fallon M. Acetabular involvement in osteonecrosis of the femoral head. J Bone Joint Surg [Am] 1999;81:60-5.
11. Cornell CN, Salvati EA, Pellicci PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North Am 1985;16:757-69.
12. Kim YH, Oh JH, Oh SH. Cementless total hip arthroplasty in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res 1995;(320):73-84.
13. Salvati EA, Cornell CN. Long-term follow-up of total hip replacement in patients with avascular necrosis. Instr Course Lect 1988;37:67-73.
14. Modrego FJ, Molina J. Self-expanding cup CLS. 10 years results. Rev Fac Cien Med Univ Nac Cordoba 2004;61:7-12. [Abstract]
15. Cech O, Dzupa V, Svatos F. The uncemented cup of the CLS Spotorno joint endoprosthesis - 5 years’ results. Acta Chir Orthop Traumatol Cech 2001;68:10-7. [Abstract]
16. Chiu KH, Shen WY, Ko CK, Chan KM. Osteonecrosis of the femoral head treated with cementless total hip arthroplasty. A comparison with other diagnoses. J Arthroplasty 1997; 12:683-8.
17. Charnley J, Halley DK. Rate of wear in total hip replacement. Clin Orthop Relat Res 1975;(112):170-9.
18. Griffith MJ, Seidenstein MK, Williams D, Charnley J. Socket wear in Charnley low friction arthroplasty of the hip. Clin Orthop Relat Res 1978;(137):37-47.
19. Jessen N, Nickel A, Schikora K, Buttner-Janz K. Metal/metal - a new (old) hip bearing system in clinical evaluation. Prospective 7-year follow-up study. Orthopade 2004;33:594-602. [Abstract]
20. Roberts J, Meek RM, Roberts P, Grigoris P. Metal-on-metal hip resurfacing. Scott Med J 2005;50:10-2.