A Comparison Between Total Hip Replacement for Osteonecrosis and Degenerative Joint Disease

Abstract

There has been some reluctance to perform total hip replacement (THR) on younger patients with osteonecrosis because of the poor results reported in the earlier literature. To determine the extent to which advances in surgical techniques and prosthesis design have led to improved results, we evaluated 203 THRs performed for osteonecrosis and compared them to 300 performed for degenerative joint disease. Two femoral and 3 acetabular components were used. The failure rate for all femoral and acetabular components combined was 3.7% (22 of 600) in degenerative joint disease and 10.1% (41 of 406) in osteonecrosis. There was a clear correlation between failure and the specific component used in both groups, although the prevalence of failure was greater in patients with osteonecrosis for each prosthetic component (Figures 1 , 2 ). Possible explanations for these differences are discussed. Results with the most recently used acetabular component, the noncemented HGP-1, were markedly improved over earlier components in both conditions, with only 1 failure in 111 hips with osteonecrosis (0.9%) and no failures in 124 hips with degenerative joint disease. The overall results of THR in patients with osteonecrosis were considerably better than those reported in the earlier literature and are presumably related to improved component design and surgical technique. Conventional THR is currently a good option for patients with advanced stages of osteonecrosis, and that similar surgical indications should be used for patients with degenerative joint disease and other disorders.