J Korean Orthop Assoc.  2010 Aug;45(4):273-280.

Bipolar Hip Arthroplasty vs. Total Hip Arthroplasty for Osteonecrosis of the Femoral Head

• Kim SS
• Sohn SK
• Kim HJ
• Sun SK

Abstract

PURPOSE
To retrospectively compare surgical outcomes between bipolar hip arthroplasty and total hip arthroplasty in patients with osteonecrosis of the femoral head. MATERIALS AND
METHODS
Between April 2000 and July 2004, we reviewed 51 cases with Ficat stage III osteonecrosis of the femoral head that underwent bipolar hip arthroplasty (BHA) and 52 cases that received total hip arthroplasty (THA). The minimum follow-up period was 5 years. All prostheses used in the current study had cementless stem and metal-on-polyethylene bearings. We analyzed clinical and radiological results, reoperation, operation time and blood loss the BHA group (mean follow-up of 81 months) and the THA group (82 months).
RESULTS
There were no statistically differences between the two groups in preoperative and postoperative mean Harris hip scores. There were no significant differences between the two groups in clinical results, including persistent inguinal pain and radiologic changes around the acetabular cup and femoral stem (p>0.05). Three cases (5.9%) in the BHA group and 5 cases (7.7%) in the THA group underwent revisions. The mean operation time was 96 minutes in the BHA group and 118 minutes in the THA group. Mean blood loss was 625 cc in the BHA group, and 784 cc in the THA group. The differences between the two groups in mean operation time and blood loss were significant (p<0.05).
CONCLUSION
The BHA group, which used cementless stem and metal-on-polyethylene bearings for Ficat stage III osteonecrosis of the femoral head, showed no significant differences from the THA group in postoperative radiologic change, clinical evaluation, and reoperation during 81 months of mean follow-up.

Keyword

osteonecrosis; femoral head; bipolar hip arthroplasty; total hip arthroplasty

MeSH Terms

Arthroplasty
Butylated Hydroxyanisole
Follow-Up Studies
Head
Hip
Humans
Osteonecrosis
Prostheses and Implants
Reoperation
Retrospective Studies
Tacrine
Ursidae
Butylated Hydroxyanisole
Tacrine

Figure

• 

  Figure 1 Radiographs of a 54-year-old man treated with bipolar hip arthroplasty in one hip and total hip arthroplasty in the other. (A, B) The patient was suffering from osteonecrosis of the right femoral head with flattening (Ficat Stage III) and osteonecrosis of the left femoral head with a preserved spericity (Ficat Stage IIA). (C) Postoperative radiograph after receiving total hip arthroplasty in the right hip. (D) In the left side, femoral head flattening was found at the 1.5-year follow-up. (E) Postoperative radiograph after receiving bipolar hip arthroplasty in the left hip. (F) No acetabular cup migration or femoral stem loosening was seen on the radiograph at 6 years after bipolar hip arthroplasty. The patient still had a satisfactory result in the both sides at the last follow-up.

• 

  Figure 2 Radiographs of a 76-year-old woman treated with bipolar hip arthroplasty in right hip. (A) Preoperative radiograph shows asuperomedial migration of head. (B, C) Preoperative T1 weighted (B) & T2 weighted (C) MRI shows subchondral collapse without flattening. (D) Postoperative radiograph after receiving bipolar hip arthroplasty in the right hip. (E) A migration of outer head was found at the 3-year follow-up. (F) A migration of outer head and sclerotic change of acetabulum were progressed at the 5.4-year follow-up.

Reference

1. Cabanela ME. Bipolar versus total hip arthroplasty for avascular necrosis of the femoral head. A comparison. Clin Orthop Relat Res. 1990. 261:59–62.

2. Takaoka K, Nishina T, Ohzono K, et al. Bipolar prosthetic replacement for the treatment of avascular necrosis of the femoral head. Clin Orthop Relat Res. 1992. 277:121–127.

3. Min BW, Song KS, Jun SH. Bipolar versus total hip arthroplasty for the osteonecrosis of the femoral head: retrospective matched pair study. J Korean Hip Soc. 2003. 15:245–251.

4. Muraki M, Sudo A, Hasegawa M, Fukuda A, Uchida A. Long-term results of bipolar hemiarthroplasty for osteoarthritis of the hip and idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2008. 13:313–317.

5. Chan YS, Shih CH. Bipolar versus total hip arthroplasty for hip osteonecrosis in the same patient. Clin Orthop Relat Res. 2000. 379:169–177.

6. Shin HK, Jung HJ, Choi JY, Kim HK, Kim YH, Lee JK. Bipolar hip arthroplasty in patients with osteonecrosis of the femoral head. J Korean Hip Soc. 2004. 16:435–440.

7. Lee JW, Kim ES, Lee CH, et al. Bipolar hip arthroplasty in patients with avascular necrosis of the femoral head. J Korean Hip Soc. 2001. 13:253–258.

8. Beaulé PE, Amstutz HC. Management of Ficat stage III and IV osteonecrosis of the hip. J Am Acad Orthop Surg. 2004. 12:96–105.

9. Charnley J.. Charnley J, editor. Numerical grading of clinical results. 1979. New York: Springer-Verlag;20–24.

10. Steinberg ME, Corces A, Fallon M. Acetabular involvement in osteonecrosis of the femoral head. J Bone Joint Surg Am. 1988. 81:60–65.

11. Gruen TA, McNeice GM, Amstuz HC. "Mode for failure" of cemented stem-type femoral components: a radiographic analysis of loosenging. Clin Orthop Relat Res. 1979. 141:17–27.

12. Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990. 257:107–128.

13. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am. 1973. 55:1629–1632.

14. Kawamura H, Dunbar MJ, Murray P, Bourne RB, Rorabeck CH. The porous coated anatomic total hip replacement. A ten to fourteen-year follow-up study of a cementless total hip arthroplasty. J Bone Joint Surg Am. 2001. 83-A:1333–1338.

15. Murzic WJ, McCollum DE. Hip arthroplasty for osteonecrosis after renal transplantation. Clin Orthop Relat Res. 1994. 299:212–219.

16. Capello WN, D'Antonio JA, Manley MT, Feinberg JR. Hydroxyapatite in total hip arthroplasty. Clinical results and critical issues. Clin Orthop Relat Res. 1998. 355:200–211.

17. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976. 121:20–32.

18. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969. 51:737–755.

19. Tsumura H, Torisu T, Kaku N, Higashi T. Five- to fifteen-year clinical results and the radiographic evaluation of acetabular changes after bipolar hip arthroplasty for femoral head osteonecrosis. J Arthroplasty. 2005. 20:892–897.

20. Dalldorf PG, Banas MP, Hicks DG, Pellegrini VD Jr. Rate of degeneration of human acetabular cartilage after hemiarthroplasty. J Bone Joint Surg Am. 1995. 77:877–882.

21. Lachiewicz PF, Desman SM. The bipolar endoprosthesis in avascular necrosis of the femoral head. J Arthroplasty. 1988. 3:131–138.

22. Ito H, Matsuno T, Kaneda K. Bipolar hemiarthroplasty for osteonecrosis of the femoral head. A 7- to 18-year followup. Clin Orthop Relat Res. 2000. 374:201–211.

23. 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. 424:161–165.

24. Athanasiou KA, Agarwal A, Dzida FJ. Comparative study of the intrinsic mechanical properties of the human acetabular and femoral head cartilage. J Orthop Res. 1994. 12:340–349.

25. Kim KS, Chung YY, Kim JH, Jung BO. Cementless bipolar hemiarthroplasty for femoral head osteonecrosis. J Korean Hip Soc. 2000. 12:275–281.

26. Kim JH, Lee S, Ko DO, Park KY, Jeon YW, Yang SJ. Analysis of risk factors affecting degeneration of the acetabular cartilage after bipolar hemiarthroplasty. J Korean Hip Soc. 2007. 19:71–76.

27. Kim HJ, Ha JH, Kim SR, Kim YM, Kim ST. A comparison of bipolar hemiarthroplasty and total hip arthroplasty performed in the same patients of bilateral osteonecrosis of the femoral head. J Korean Hip Soc. 1998. 10:98–105.

28. Yoo MC, Cho YJ, Kim KI, et al. Long term follow up study of cementless total hip arthroplasty for osteonecrosis of the femoral head -minimum 10-year follow up study. J Korean Hip Soc. 2004. 16:1–9.

29. Kim SY, Kim YG, Yeo JY, Kim DH, Ihn JC. Ceramic-on-ceramic bearing total hip arthroplasty in young patients with osteonecrosis of femoral head. J Korean Orthop Assoc. 2004. 39:233–238.

30. Yoo JJ, Kim YM, Yoon KS, Koo KH, Song WS, Kim HJ. Alumina-on-alumina total hip arthroplasty A five-year minimum follow-up study. J Bone Joint Surg Am. 2005. 87:530–535.