Abstract
Objective: There are various Surgical methods for treatment of avascular necrosis of femoral head like core decompression, vascular and avascular bone grafting, osteotomies, hemiarthroplasty, total hip replacement and arthrodesis. The aim of this prospective study was to evaluate the Outcomes of Bipolar Hemiarthroplasty in Young Adults as Treatment of Avascular Necrosis of Femoral Head.
Patients & Method: This prospective study was conducted on 25 relatively young male adults with mean age of 39 years (range 28 to 59 yaers). Approximately all the patients were of avascular necrosis of femoral head with nearly normal acetabulum. Superficial smoothening of the acetabulum was also performed in few cases. Snug fitting of the trial cups was confirmed and care was taken that there is no gross movement between outer cup and acetabulum. We believe that Bipolar prosthesis is easy to implant and can be done in the above age group instead of conventional hemiarthroplasty and more extensive surgery like total hip replacement. Due to double mobility it protects the acetabular cartilage for a quite long time with the increased range of motion in the hip joint. Clinical follow up was done by using Harris hip score (HHS) system.
Results: All patients, were regularly followed up and longest follow up is 3 years in five patients and shortest follow is three months in three patients. The HHS significantly improved from a preoperative value of 39.3 (range, 54-30) to a postoperative value of 89.12 (range 74-96). According to HHS grades, the final outcome was excellent in 14 hips, good in 8 and fair in 3 hips. Complications seen were wound infection in one case.
Conclusion: Bipolar hemiarthroplasty with tight fitting cup for avascular necrosis of femur neck has a very low chances of groin pain, erosion of acetabulam, and revision during follow up
Keywords: Femoral head, avascular necrosis, bipolar hemiarthroplasty.
References
- Hamilton TW, Goodman SM, Figgie M. SAS weekly rounds: Avascular necrosis. HSS J 2009;5:99- 113.
- Steinberg ME, Corces A, Fallon M. Acetabular involvement in osteonecrosis of the femoral head. J Bone Joint Surg Am 1999;81:60-5.
- Lee SB, Sugano N, Nakata K, Matsui M, Ohzono K. Comparison between bipolar hemiarthroplasty and THA for osteonecrosis of the femoral head. Clin Orthop Relat Res 2004;424:161-5.
- Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: Management in the 21 st century. Instr Course Lect 2003; 52:337-55.
- Anderson L.D., Hamsa W.R. and Waring T.L.(1964): Femoral head prosthesis-A review of three hundred and fifty operations and their results. J. Bone Joint Surg.,46-A: 1049-65.
- Bateman JE. The classic: Single-assembly total hip prosthesis-preliminary report 1974. Clin Orthop Relat Res 2005;441:16-8.
- Giliberty RP. Bipolar endoprosthesis minimizes protrusioacetabuli, loose stems. Orthop Rev 1985;14:27.
- Krein S.W. and Chao E.Y.(1984) : Biomechanics of bipolar hip endoprosthesis. J Orthop.Res.2:356
- Hwang KT, Kim YH, Kim YS, Choi IY. Is bipolar hemiarthroplasty a reliable option for Ficat stage III osteonecrosis of the femoral head? 15- to 24-year follow up study. Arch Orthop Trauma Surg 2012;132:1789-96.
- Dinkar H., and Murray W.R.(1979):The universal proximal femoral endoprosthesis-a short term comparision with conventional hemiarthroplasty.J.Bone Joint Surg. 61-A:1167
- Cuckler JM, Moore KD, Estrada L. Outcome of hemiresurfacing in osteonecrosis of the femoral head. Clin Orthop Relat Res 2004;429:146-50.
- Moriya M, Uchiyama K, Takahira N, Fukushima K, Yamamoto T, Hoshi K, et al. Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head. Int Orthop 2012;36:2041-7.
- van Egmond PW, Taminiau AH, van der Heide HJ. Hemiarthroplasties in young patients with osteonecrosis or a tumour of the proximal femur; an observational cohort study. BMC Musculoskelet Disord 2013;14:31.
- Chan YS, Shih CH. Bipolar versus total hip arthroplasty for hip osteonecrosis in the same patient. Clin Orthop Relat Res 2000;379:169-77.
- Steinberg ME. Management of avascular necrosis of the femoral head: An overview. Instr Course Lect 1988;37:41-50.
- Cabanela ME. Bipolar versus total hip arthroplasty for avascular necrosis of the femoral head. A comparison. Clin Orthop Relat Res 1990;261:59-62.
- .K. Singh, K.D.Tripathi and M.M. Sahoo, Bipolar Arthroplasty in young adults . IJO sept 1994 Vol 28 No.3
Corresponding Author
Dr Bijayendra Nath Chaturvedi
Senior Resident, Department of Orthopaedics, Nalanda Medical College & Hospital, Patna
DOI: https://dx.doi.org/10.18535/jmscr/v10i6.06
