Resurfacing of only the femoral head for osteonecrosis. Long-term follow-up study.

Fourteen patients (21 hips) with osteonecrosis of the femoral head with collapse had the femoral head resurfaced with a cemented titanium shell. All of the femoral heads were Ficat stage III or IV. Of the 21 surgeries, 7 were failures. Treatment for all 4 patients with sickle cell disease or trait failed (100%). When the cases of 17 patients who did not have sickle cell disease or trait were reviewed separately, the success rate was 14 of 17 (82%). The follow-up periods (all > 5 years) of the 14 successful patients in this group averaged 6.2 years, and their average Harris hip score was 87 (10 excellent, 4 good). Of the 14 successes, 10 patients had a follow-up period longer than 5 years (average, 7.7 years) and an average Harris hip score of 94 (7 excellent, and 3 good). There was no evidence of loosening and there was no osteolysis. It is concluded that this operation provides an alternative to hemiarthroplasty, total joint arthroplasty surgery, or bipolar arthroplasty. This is a time-buying first-stage operation and, for younger patients, will not last a lifetime. The concept appears prudent because the surgical procedure is directed at the site of primary disease, the femoral head.