Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review

Abstract

The primary goals of this critical literature review were to determine whether revision rates of primary total hip arthroplasty in patients with osteonecrosis differ based on the underlying associated risk factors and diagnoses, whether the outcomes of this procedure have improved over the past two decades, and to compare outcomes based on study level of evidence. A systematic literature review yielded 67 reports representing 3,277 hips in 2,593 patients who had a total hip arthroplasty for osteonecrosis of the femoral head. Stratification of outcomes by associated risk factors or diagnoses revealed significantly lower revision rates in patients with idiopathic disease, systemic lupus erythematosus, and after heart transplant, and significantly higher rates in patients with sickle cell disease, Gaucher disease, or after renal failure and/or transplant. There was a significant decrease in revision rates between patients operated upon before 1990 versus those in 1990 or later, with rates of 17% and 3%, respectively. The results for arthroplasties performed in 1990 or later were similar to those for all hips in publicly reported national joint registries. Certain risk factors were associated with higher revision rates in patients with osteonecrosis who were treated by total hip arthroplasty. However, most patients (82%) do not have these associated negative risk factors. Overall, this critical literature review provides evidence that osteonecrosis itself, or when associated with the most common risk factors and/or diagnoses, is not associated with poor outcomes in total hip arthroplasty.

S3-Guideline non-traumatic adult femoral head necrosis

“…• Revision rates after THR for N-ANFH have significantly fallen since 1990 and are now similar to global failure rates reported nationally [122,[150][151][152].…”

Hip replacement in femoral head osteonecrosis: current concepts

“…Patients with ONFH have similar failure rates after THA than the general population. There was a significant decrease in revision rates between patients operated upon before 1990 versus those in 1990 or later, with rates of 17% and 3%, respectively (28). However, some risk factors are associated with higher or lower revision rates.…”

Cytotherapy of osteonecrosis of the femoral head: a mini review

“…Since the pathogenesis and aetiology of nontraumatic osteonecrosis of the femoral head (ONFH) has not been revealed completely, current treatment of ONFH simply focuses on preventing irreversible complications, namely, biomechanical collapse of the femoral head and osteoarthritis of the hip joint [1], although tremendous progress has been achieved in all aspects [2][3][4][5][6]. In Free vascularised fibular grafting, for example, the aim of the operation is to gain complete decompression of the medullary cavity, remove necrotic bone, provide mechanical support and vital cellular replacement [7][8][9].…”