TOTAL HIP ARTHROPLASTY FOR AVASCULAR NECROSIS OF THE HIP
Total hip arthroplasty is one of the most common surgical procedures for arthritis that develops from avascular necrosis of the hip. Total hip arthroplasty provides an excellent relief of hip pain. Total hip arthroplasty can be used after failure of earlier surgical treatments, including core decompression, fibular grafting, injection of bioactive materials for regeneration of the bone in the femoral head and to revise the hip resurfacing.
However, the results of total hip replacement in treating avascular necrosis of the femoral head are inferior as compared to total hip replacement done for osteoarthritis or rheumatoid arthritis. The higher complications and the failure rates may be related to the steroid use that is necessary for treating comorbidities that are associated and are responsible for avascular necrosis of the femoral head, associated sickle cell anemia, systemic lupus erythematosus, and other comorbid conditions including renal failure. These associations may be responsible for higher revision surgery. The comorbidities may be responsible for increased intra operative bleeding time, the abnormal shape of the bone.
Total hip replacement after osteotomy around the hip is especially challenging. Osteotomy alters the shape of the hip and the anatomy of the hip. This may lead to incorrect implant insertion and placement during total hip replacement, if the hip replacement is done after osteotomy for initial treatment of avascular necrosis. Additionally, there may be prolonged operative time that increases the risk of intraoperative and postoperative complications.
Total hip arthroplasty done using modern technology and current bearing surfaces should improve the outcome of the joint replacements in patients who have osteonecrosis of the femoral head. With newer designs of implants and with improved fixation abilities of prosthesis, the stability of the interface between the components and the bone should improve leading to better survival rates. Modern materials and surgical techniques used in joint replacement surgery should decrease the wear rates leading to decrease in osteolysis and improved surgical outcomes.
As an example, today we have excellent cementation techniques that improve the interface between the cement and the bone. Better fixation should also improve the long-term results of hip replacement surgery. It is critically important to select cup and femoral components according to the geometry of the bone, place the components according to the bone strength and geometry. Careful attention needs to be paid to the cortical thickness and the shape of the bone so that better stability can be achieved.
This will lead to decreased incidence of intro operative fractures, decreased wear rates and possibility of dislocation will be reduced. Significant wear leading to implant loosening and joint dislocations have been a major cause of hip revision. I believe that using modern techniques and materials we can achieve a high success rate after total hip arthroplasty done for avascular necrosis.
Why choose Dr. Karkare?
Dr. Karkare is a leading orthopedic surgeon in New York City with multiple locations on Long Island. He provides patients with the most effective and advanced treatments for avascular necrosis.
His extensive experience and in-depth knowledge of bone and joint health issues mean he is uniquely positioned to help patients understand the cause of their condition while creating customized solutions based on each patient’s unique needs and health profiles.
If you’ve been experiencing any type of joint or bone pain or weakness, the first step is to evacuate toward ensuring you get the best and most appropriate care for complete recovery and optimum health.