Hip & pelvis

The Korean Hip Society (대한고관절학회)
권호 표지
DOI QR코드

DOI QR Code

Hip Resurfacing Arthroplasty after Failure of Tantalum Rod Insertion in Patients with Osteonecrosis of the Femoral Head

  • Yoon Je Cho (Department of Orthopaedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University) ;
  • Kee Hyung Rhyu (Department of Orthopaedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University) ;
  • Young Soo Chun (Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University) ;
  • Hyun Gon Gwak (Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University)
  • Received : 2022.04.17
  • Accepted : 2022.10.16
  • Published : 2022.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The purpose of this study was to examine the clinical outcomes and efficacy of hip resurfacing arthroplasty (HRA) in patients with osteonecrosis of the femoral head after the failure of porous tantalum rod insertion without rod removal. Materials and Methods: Conversion to hip resurfacing arthroplasty was performed in 10 patients (11 hips) with a mean period of 14.9 months after the primary surgery. The mean follow-up period was 73.7 months. Analysis of pre and postoperative range of motion (ROM), University of California at Los Angeles (UCLA) activity score, modified Harris hip score, and visual analog scale (VAS) pain score was performed. Radiographic analysis of component loosening and osteolysis was performed. Results: The postoperative ROM showed significant improvement (P<0.05), excluding flexion contracture. The modified Harris hip score showed improvement from 65.82 to 96.18, the UCLA score showed improvement from 4.18 to 8.00, and the VAS pain score was reduced from 6.09 to 1.80. All scores showed statistically significant improvement (P<0.05). No component loosening or osteolysis was detected by radiographic analysis. Conclusion: Satisfactory results were obtained from conversion hip resurfacing arthroplasty after failure of porous tantalum rod insertion without rod removal. The findings of this study demonstrate the advantages of HRA, including no risk of trochanteric fracture and no bone loss around the tantalum rod. In addition, the remaining porous tantalum rod provided mechanical support, which reduced the potential risk of femoral neck fracture or loosening. This technique can be regarded as a favorable treatment option.

Keywords

References

  1. Vail TP, Urbaniak JR. Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg Am. 1996;78:204-11. https://doi.org/10.2106/00004623-199602000-00006
  2. Tang CL, Mahoney JL, McKee MD, Richards RR, Waddell JP, Louie B. Donor site morbidity following vascularized fibular grafting. Microsurgery. 1998;18:383-6. https://doi.org/10.1002/(sici)1098-2752(1998)18:6<383::aidmicr8>3.0.co;2-5
  3. Floerkemeier T, Thorey F, Daentzer D, et al. Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. Int Orthop. 2011;35:489-95. https://doi.org/10.1007/s00264-009-0940-9
  4. Lee GW, Park KS, Kim DY, Lee YM, Eshnazarov KE, Yoon TR. Results of total hip arthroplasty after core decompression with tantalum rod for osteonecrosis of the femoral head. Clin Orthop Surg. 2016;8:38-44. https://doi.org/10.4055/cios.2016.8.1.38
  5. Olsen M, Lewis PM, Morrison Z, McKee MD, Waddell JP, Schemitsch EH. Total hip arthroplasty following failure of core decompression and tantalum rod implantation. Bone Joint J. 2016;98-B:1175-9. https://doi.org/10.1302/0301-620X.98B9.37252
  6. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999;81:907-14. https://doi.org/10.1302/0301-620x.81b5.9283
  7. Bobyn JD, Poggie RA, Krygier JJ, et al. Clinical validation of a structural porous tantalum biomaterial for adult reconstruction. J Bone Joint Surg Am. 2004;86-A Suppl 2:123-9. https://doi.org/10.2106/00004623-200412002-00017
  8. Varitimidis SE, Dimitroulias AP, Karachalios TS, Dailiana ZH, Malizos KN. Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years. Acta Orthop. 2009;80:20-5. https://doi.org/10.1080/17453670902804877
  9. Tsao AK, Roberson JR, Christie MJ, et al. Biomechanical and clinical evaluations of a porous tantalum implant for the treatment of early-stage osteonecrosis. J Bone Joint Surg Am. 2005;87 Suppl 2:22-7. https://doi.org/10.2106/JBJS.E.00490
  10. Aldegheri R, Taglialavoro G, Berizzi A. The tantalum screw for treating femoral head necrosis: rationale and results. Strategies Trauma Limb Reconstr. 2007;2:63-8. https://doi.org/10.1007/s11751-007-0021-9
  11. Nadeau M, Seguin C, Theodoropoulos JS, Harvey EJ. Short term clinical outcome of a porous tantalum implant for the treatment of advanced osteonecrosis of the femoral head. Mcgill J Med. 2007;10:4-10. https://doi.org/10.26443/mjm.v10i1.462
  12. Shuler MS, Rooks MD, Roberson JR. Porous tantalum implant in early osteonecrosis of the hip: preliminary report on operative, survival, and outcomes results. J Arthroplasty. 2007;22:26-31. https://doi.org/10.1016/j.arth.2006.03.007
  13. Veillette CJ, Mehdian H, Schemitsch EH, McKee MD. Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88 Suppl 3:48-55. https://doi.org/10.2106/JBJS.F.00538
  14. Liu G, Wang J, Yang S, Xu W, Ye S, Xia T. Effect of a porous tantalum rod on early and intermediate stages of necrosis of the femoral head. Biomed Mater. 2010;5:065003. https://doi.org/10.1088/1748-6041/5/6/065003
  15. Beaule PE, Amstutz HC. Management of Ficat stage III and IV osteonecrosis of the hip. J Am Acad Orthop Surg. 2004;12:96-105. https://doi.org/10.5435/00124635-200403000-00005
  16. 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. https://doi.org/10.1016/j.arth.2012.01.025
  17. Kerboul M, Thomine J, Postel M, Merle d'Aubigne R. The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br. 1974;56:291-6. https://doi.org/10.1302/0301-620X.56B2.291
  18. Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am. 2006;88 Suppl 3:35-40. https://doi.org/10.2106/JBJS.F.00535
  19. Steinberg ME, Oh SC, Khoury V, Udupa JK, Steinberg DR. Lesion size measurement in femoral head necrosis. Int Orthop. 2018;42:1585-91. https://doi.org/10.1007/s00264-018-3912-0
  20. Park CW, Lim SJ, Kim JH, Park YS. Hip resurfacing arthroplasty for osteonecrosis of the femoral head: implant-specific outcomes and risk factors for failure. J Orthop Translat. 2020;21:41-8. https://doi.org/10.1016/j.jot.2019.12.005
  21. Tanzer M, Bobyn JD, Krygier JJ, Karabasz D. Histopathologic retrieval analysis of clinically failed porous tantalum osteonecrosis implants. J Bone Joint Surg Am. 2008;90:1282-9. https://doi.org/10.2106/JBJS.F.00847
  22. Zhang X, Wang J, Xiao J, Shi Z. Early failures of porous tantalum osteonecrosis implants: a case series with retrieval analysis. Int Orthop. 2016;40:1827-34. https://doi.org/10.1007/s00264-015-3087-x
  23. Fernandez-Fairen M, Murcia A, Iglesias R, Sevilla P, Manero JM, Gil FJ. Analysis of tantalum implants used for avascular necrosis of the femoral head: a review of five retrieved specimens. J Appl Biomater Funct Mater. 2012;10:29-36. https://doi.org/10.5301/JABFM.2012.9273
  24. Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg Br. 2004;86:177-84. https://doi.org/10.1302/0301-620x.86b2.14600
  25. Clarke MT, Lee PT, Villar RN. Dislocation after total hip replacement in relation to metal-on-metal bearing surfaces. J Bone Joint Surg Br. 2003;85:650-4. https://doi.org/10.1302/0301-620X.85B5.13993
  26. Shimmin AJ, Bare J, Back DL. Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am. 2005;36:187-93, ix. https://doi.org/10.1016/j.ocl.2005.01.002
  27. Mont MA, Seyler TM, Marker DR, Marulanda GA, Delanois RE. Use of metal-on-metal total hip resurfacing for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88 Suppl 3:90-7. https://doi.org/10.2106/JBJS.F.00543
  28. Tai CL, Chen YC, Hsieh PH. The effects of necrotic lesion size and orientation of the femoral component on stress alterations in the proximal femur in hip resurfacing- a finite element simulation. BMC Musculoskelet Disord. 2014;15:262. https://doi.org/10.1186/1471-2474-15-262