Conservative Hip Conservative Hip Replacement for Replacement for avascular necrosis avascular necrosis E. Munting, P. Poilvache E. Munting, P. Poilvache Cliniques Universitaires Saint- Cliniques Universitaires Saint- Luc, Bruxelles Luc, Bruxelles Clinique Saint-Pierre, Ottignies Clinique Saint-Pierre, Ottignies Hôpital de Waterloo-Braine Hôpital de Waterloo-Braine
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Conservative Hip Replacement for avascular necrosis E. Munting, P. Poilvache Cliniques Universitaires Saint-Luc, Bruxelles Clinique Saint-Pierre, Ottignies.
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Conservative Hip Conservative Hip
Replacement for Replacement for
avascular necrosisavascular necrosisE. Munting, P. PoilvacheE. Munting, P. PoilvacheCliniques Universitaires Saint-Luc, Cliniques Universitaires Saint-Luc,
DXA StudyDXA Study(prospective, 21 hips, 6-9 (prospective, 21 hips, 6-9 y. F-up)y. F-up) BMD is maintained in the BMD is maintained in the
proximal femurproximal femur In patients with low initial values In patients with low initial values
asas
compared to the controlateral compared to the controlateral side, side, BMD increases after surgeryBMD increases after surgery J. Arthroplasty 12, 373-9, 1997
Pilot studyPilot study
04/1989 – 01/199204/1989 – 01/1992
43 patients, 48 hips43 patients, 48 hips
33 males, 15 females33 males, 15 females
Mean age: 36.4 years (19 – 49)Mean age: 36.4 years (19 – 49)
Etiology Etiology (pilot study n (pilot study n = 48)= 48)
ResultsResults (pilot study (pilot study n: n: 4848))
Follow-up : 14 to 16 yearsFollow-up : 14 to 16 years 1 patient (2 hips) deceased1 patient (2 hips) deceased 3 lost to follow-up (living abroad)3 lost to follow-up (living abroad) 18 revised18 revised : : 8 early revisions 8 early revisions
(malposition)(malposition) 10 late revisions 10 late revisions (polyethylene wear)(polyethylene wear)
26 hips known to be functional.26 hips known to be functional.
Revisions secondary to Revisions secondary to implant malposition implant malposition (n=8)(n=8)
Varus positionVarus position : :
CDA CDA << 120° (n=6) 120° (n=6)
lack of contactlack of contact with with
the bone resection the bone resection
(n=2) (n=2)
Second seriesSecond series
01/1995 – 05/200001/1995 – 05/2000
154 hips154 hips
Mean age: 40.8 years (17 – 56 years)Mean age: 40.8 years (17 – 56 years)
Second series Second series (01/1995 – (01/1995 – 05/2000)05/2000)
154 hips154 hips
14 early revisions14 early revisions
4 late revisions for poly. 4 late revisions for poly.
wear (alumina/poly.)wear (alumina/poly.)
Survival probability: Survival probability:
femoral componentfemoral component
0,70
0,75
0,80
0,85
0,90
0,95
1,00
0 2 4 6 8 10 12
( Kaplan - Meier )
n = 48 pilot studyn = 48 pilot study
y
n = 154 second seriesn = 154 second series
Third series Third series (06/2000 – (06/2000 – 11/2005)11/2005)
From 04/1989 to 02/2003From 04/1989 to 02/2003 56 patients (50 males/6 females)56 patients (50 males/6 females) 64 hips64 hips Mean age: 49 years (22 – 64)Mean age: 49 years (22 – 64) Mean follow-up: 7 yearsMean follow-up: 7 years 5 revisions5 revisions 59 implants still in place59 implants still in place
Aseptic necrosis (n: Aseptic necrosis (n: 64)64)
5 revisions (7.8%)5 revisions (7.8%)
Mean age at reoperation: 52 yearsMean age at reoperation: 52 years
Mean time in situ: 3 yearsMean time in situ: 3 years
Reasons for revision:Reasons for revision:
Varus positioning causing pain or Varus positioning causing pain or
1 patient complaining of groin pain (psoas 1 patient complaining of groin pain (psoas
tendinitis?)tendinitis?)
1 late instability (poly. wear)1 late instability (poly. wear)
2 patients with mild trochanteric pain (screw?)2 patients with mild trochanteric pain (screw?)
7 years7 years 14 years14 years
Need for improved Need for improved instrumentsinstruments
The cutting and drilling guides should be monoblock, in order to avoid rotational mismatch
ConclusionsConclusions This experience supports that This experience supports that a purely a purely
metaphyseal anchorage of a stemless implant metaphyseal anchorage of a stemless implant
can provide a long lasting fixationcan provide a long lasting fixation This type of implant is This type of implant is suitable even when the suitable even when the
femoral head is destructedfemoral head is destructed It permits the use of a It permits the use of a ceramic on ceramic ceramic on ceramic
bearingbearing It is conservative, as It is conservative, as a primary implant can a primary implant can
easily be used if revision is neededeasily be used if revision is needed