Outcomes of Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head Following Surgical Treatment of Brain Tumors

Abstract

Corticosteroids have been widely used in patients with brain tumors to reduce tumor-associated edema and neurological deficits. This study examined the outcomes of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) following brain tumor surgery. We identified 34 THAs performed in 26 patients with steroid-induced ONFH among 9254 patients undergoing surgical treatment for primary brain tumors. After propensity score matching with demographics, 68 THAs (52 patients) in ONFH unrelated to brain tumors were selected as the control group. At the time of THA, 54% of brain tumor patients had neurological sequelae and 46% had adrenal insufficiency. After THA, patients with brain tumor required longer hospital stay, reported a lower functional score, and showed a higher rate of heterotopic ossification compared to the control group. However, hip pain score improved significantly after THA in the brain tumor group, and did not differ from that of the control group (P-value = 0.168). Major complication rates were similar (2.9% and 1.5% for the brain tumor and control groups, respectively; P-value = 1.000), and implant survivorships were not different at 7 years (100% and 98.1% for the brain tumor and control groups, respectively; P-value = 0.455). Our findings suggest that THA can be safely performed to reduce hip pain in patients with steroid-induced ONFH after surgical treatment of primary brain tumors.

Risk factors for osteonecrosis of the femoral head in brain tumor patients receiving corticosteroid after surgery

“…Only a few case reports and retrospective observational studies have been performed [ 16 , 36 – 38 ], however, there is limited clinical information available regarding the relationship between ONFH and brain tumor. Although THA, a definitive surgical treatment for ONFH, can be a reliable one in brain tumor patients [ 19 ], ONFH occurring in brain tumor are still a grave concern for neurosurgeons as well as related professionals.…”

“…Furthermore, pituitary dysfunction, a devastating sequelae of brain tumor, has been reported to be associated with ONFH in brain tumor patients [17,18]. Recently, Lim et al reported favorable clinical results and high patient satisfaction in total hip arthroplasty (THA) performed on corticosteroid-induced ONFH after surgical removal of a primary brain tumor [19].…”

Effects of disusing closed suction drainage in simultaneous bilateral total hip arthroplasty: A retrospective cohort study

“…The occurrence of venous thromboembolic event, dislocation, periprosthetic joint infection, periprosthetic femoral fracture, and aseptic loosening of implants were considered major surgical complications. The combined range of motion (ROM) was determined as the sum of degrees in flexion to extension, adduction to abduction, and internal-to-external rotation of the hip [ 30 ]. Clinical scores were assessed using the Harris Hip Score (HHS) system and University of California, Los Angeles (UCLA) activity score.…”