TOTAL RESURFACING ARTHROPLASTY AFTER FAILED HIP PRESERVING PROCEDURES FOR OSTEONECROSIS OF THE FEMORAL HEAD

The ultimate goal for treatment of osteonecrosis of femoral head (ONFH) is preserving the femoral head. We have tried to manage the patient who received failed joint preserving procedures with resurfacing arthroplasty if they fit the indicati385on. In this brief review, we wanted to clarify the role and technical concern of resurfacing arthroplasty as a salvage procedure after failed joint preserving operations for ONFH. Among 556 hips underwent resurfacing arthroplasty from September 1998 to October 2007, sixteen resurfacing arthroplasties (13 patients) were performed after failed joint preserving procedures for ONFH. Mean age at the operation was 39 years old. Seven vascularized fibular grafts, 3 multiple drillings, 3 core decompressions and 3 combined procedures were performed as initial operations. Mean duration from the index operation and resurfacing was 95 months. Mean follow up was 14 months. The patients were clinically evaluated with the Harris hip score, hip or thigh pain, and range of motion. As a radiological evaluation, we measured positions of the acetabular cup and femoral stem, radiographic changes at the neck and complications. The Harris hip score increased from 69.2 preoperatively to 89.5 at the final visit. Hip range of motions other than sagittal directions significantly improved after the operation. No patient complained of limb length discrepancy. One patient complained of unexplained hip pain, and another patient had trochanteric pain. Other than those two cases, all patients regained their pre-morbid activity level uneventfully. Radiologically, eleven femoral stems in anteroposteior and lateral radiographs were exactly aligned along the previous operative tracts. However, there were no clinical complications related to the position of femoral component. The only case that the acetabular cup was implanted in high inclination (60 degrees) experienced sustained unexplained hip pain. There was no another complications. Our experience suggests that even for the case of failed hip preserving procedures in ONFH, resurfacing arthroplasty can play a successful role as a salvage operation. Furthermore, this can be an excellent alternative between joint preserving procedures and conventional THA.