Total hip replacement after prior of the core decompression of the femoral head: efficacy and complications

Relevance. A history of core decompression using porous tantalum rods has a negative impact on the course of total hip arthroplasty surgery, the postoperative period and the frequency and nature of postoperative complications. Opinions are contradictory with regard to the effect of other techniques of necrosis decompression on total hip arthroplasty.

Purpose of the study: evaluation of the effect of core decompression of the femoral head on the intraand postoperative parameters of total hip arthroplasty surgery.

Object and methods. The study included 44 patients with osteonecrosis of the femoral head who underwent total hip arthroplasty. The first group consisted of 30 patients with osteonecrosis of the femoral head (ARCO grade II-IV) who had no previous hip surgery – primary total hip arthroplasty. The second group included 14 patients with osteonecrosis who had undergone the core decompression on the same joint (secondary total hip arthroplasty) 6–24 months earlier in stage II of the disease. The duration of surgery, blood loss volume, complications in the postoperative period, pain syndrome dynamics and hip joint function were assessed.

Results. Comparative analysis showed the absence of significant technical intraoperative complications in total hip arthroplasty: duration of operations in group I – 85 ± 25 minutes, in group II – 80 ± 20 minutes, that is, almost identical; volume of intraoperative blood loss: 300 ± 100 ml in both groups. Survival rate of the hip replacement was 100 % in both groups. Superficial inflammation of the operating wound was diagnosed in 3.3 % of group I patients and in 7.1 % of group II patients (%). Dislocation of the hip replacement was observed in one patient in Group I (primary total hip arthroplasty). Twelve months after THA, osteolysis around the hip replacement element was detected by X-ray in 6.7 % of group I patients.

Conclusion. Total hip arthroplasty in patients with a history of the core decompression of the femoral head is not accompanied by intraoperative technical difficulties and is a relatively safe surgical intervention. Prior core decompression is not an additional risk factor for intraand postoperative complications of total hip arthroplasty.

1. Shigemura T, Yamamoto Y, Murata Y, Sato T, Tsuchiya R, Mizuki N, et al. Total hip arthroplasty after failed transtrochanteric rotational osteotomy for osteonecrosis of the femoral head: A systematic review and meta-analysis. Orthop Traumatol Surg Res. 2018;104:1163-70.

2. Shigemura T, Yamamoto Y, Murata Y, Sato T, Tsuchiya R, Wada Y. Total hip arthroplasty after a previous pelvic osteotomy: A systematic review and metaanalysis. Orthop Traumatol Surg Res. 2018;104:455-63.

3. Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D. The harris hip score: Do ceiling effects limit its usefulness in orthopedics? Acta Orthop. 2010;81:703-7.

4. Tilbury C, Haanstra TM, Leichtenberg CS, Verdegaal SH, Ostelo RW, de Vet HC, et al. Unfulfilled expectations after total hip and knee arthroplasty surgery: There is a need for better preoperative patient information and education. J Arthroplasty. 2016;31:2139-45.

5. Scott CE, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br. 2012;94:974-81.

6. Jain D, Bendich I, Nguyen LL, Nguyen LL, Lewis CG, Huddleston JI, et al. Do patient expectations influence patient-reported outcomes and satisfaction in total hip arthroplasty? A prospective, multicenter study. J Arthroplasty. 2017;32:3322-7.

7. Wang Deng , Zhaolun Wang , Yixin Zhou, Hongyi Shao , Dejin Yang , Hua Li. Does prior core decompression have detrimental effect on subsequent total hip arthroplasty for osteonecrosis of the femoral head: A systematic review and meta-analysis. Orthopaedics & Traumatology: Surgery & Research. 2020;106:1553-1560.

8. Boachie-Adjei Y, Ko JWK, Cui Q. Total hip arthroplasty after failed operative treatment for osteonecrosis of the femoral head. Semin Arthroplasty. 2008;19:267-73.

9. Cheng Q, Tang JL, Gu JJ, Guo KJ, Guo WS, Wang BL et al. Total hip arthroplasty following failure of tantalum rod implantation for osteonecrosis of the femoral head with 5to 10-year follow-up. BMC Musculoskelet Disord. 2018;19:289.

10. Lee GW, Park KS, Kim DY, Lee YM, Eshnazarov KE, Yoon TR. Results of total hip arthroplasty after core decompression with tantalum rodfor osteonecrosis of the femoral head. Clin Orthop Surg. 2016;8:38-44.

11. Owens JB, Ely EE, Guilliani NM, Suarez JC, Patel PD. Removal of trabecular metal osteonecrosis intervention implant and conversion to primary total hip arthroplasty. J Arthroplasty. 2012;27:1251-3.

12. Olsen M, Lewis PM, Morrison Z, McKee MD, Waddell JP, Schemitsch EH. Total hip arthroplasty following failure of core decompression and tantalum rodimplantation. Bone Joint J . 2016;98:1175-9.

13. Pierce TP, Elmallah RK, Jauregui JJ, Verna DF, Mont MA. Outcomes of total hip arthroplasty in patients with osteonecrosis of the femoral head-a current review. Curr Rev Musculoskelet Med. 2015;8:246-51.

14. Kim YH, Park JW, Kim JS. Alumina delta-on-alumina delta bearing in cementless total hip arthroplasty in patients aged < 50 years. J Arthroplasty. 2016;31:2209-14.

15. Kim YH, Park JW, Kim JS. Long-term results of third-generation ceramic-on-ceramic bearing cementless total hip arthroplasty in young patients. J Arthroplasty. 2016;31:2520-4.

16. Aluisio FV, Urbaniak JR. Proximal femur fractures after free vascularized fibular grafting to the hip. Clin Orthop Relat Res. 1998;356:192-201.

17. Stronach BM, Duke JN, Rozensweig SD, Stewart RL. Subtrochanteric femur fracture after core decompression and placement of a tantalum strut for osteonecrosis of the femoral head. J Arthroplasty. 2010;25, https://doi.org/doi.org/10.1016/j.arth.2009.08.008

18. Ortiguera CJ, Pulliam IT, Cabanela ME (1999) Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term followup. J Arthroplast. 14:21-28.

19. Johnson A.J., Mont M.A., Tsao A.K., Jones L.C. Treatment of femoral head osteonecrosis in the United States: 16-year analysis of the nationwide inpatient sample. Clin Orthop Relat Res. 2014;472:617-623.

20. Matthias J, Bostrom MP, Lane JM. A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation. J Am Acad Orthop Surg Glob Res Rev. 2021 Nov 1;5(11):e21.00014. https://doi.org/10.5435/JAAOSGlobal-D-21-00014

21. Ancelin D, Reina N, Cavaignac E, Delclaux S, Chiron P Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28mm replacement. Orthop Traumatol Surg Res. 2016;102:1029-1034.

22. Erivan R, Caputo T, Riouach H, Villatte G, Perreira B, Descamps S, Boisgard S. Primary total hip replacement in Ficat-Arlet stage 3 and 4 osteonecrosis: a retrospective study at a minimum 12-year follow-up. Eur J Orthop Surg Traumatol. 2020 Jul;30(5):845-850. https://doi.org/10.1007/s00590-020-02644-z

23. Ollivere B., Wimhurst J.A., Clark I.M., Donell S.T. Current concepts in osteolysis. J Bone Joint Surg Br. 2012;94:10-15.

24. Howie D.W., Neale S.D., Haynes D.R., Holubowycz O.T., McGee M.A., Solomon L.B. et al. Periprosthetic osteolysis after total hip replacement: Molecular pathology and clinical management. Inflammopharmacology. 2013;21:389-396.

25. Osawa Y, Seki T, Takegami Y, Kasai T, Higuchi Y, Ishiguro N Do femoral head collapse and contralateral condition affect patient-reported quality of life and referral pain in patients with osteonecrosis of the femoral head? Int Orthop. 2018 Mar 9. https://doi.org/10.1007/s00264-018-3867-1