Total hip arthroplasty in patients with avascular necrosis of the femoral head: a 2- to 10-year follow-up.

One hundred twenty-three total hip arthroplasties were performed in 85 patients with osteonecrosis of the femoral head. There were 51 males and 34 females with an average age of 45 years. The average followup time was 4.6 years with a range of 2 to 10 years. All femoral stems and 71 sockets were fixed with acrylic cement. Fifty-two of the sockets used were placed without cement. The average Harris hip score improved from 45 points preoperatively to 92 points at the time of last followup. Of the 246 components used, 6 acetabular and 4 femoral prostheses in 7 patients have been revised (4%). Two components (0.8%) were revised for infection, 2 (0.8%) for repeated dislocation, and 6 (2.5%) for aseptic loosening. There is current radiographic loosening in 3 acetabular and 2 femoral components (2%). None of the noncemented acetabular components was either radiographically loose or revised. Within the subset of the 36 patients (52 hips) with a minimum 5-year followup (average, 6.6 years), 5 components (5%) were revised and 4 (4%) components are radiographically loose. The overall revision rate for cemented and hybrid hips at 2 to 10 years followup was 4%. The revision rate for hybrid hips alone was 2.5% in the entire series and 2% for hips with a minimum followup of 5 years. These results seem significantly better than previously reported. Using modern cement techniques and components, total hip arthroplasty can give excellent results in the young patient with avascular necrosis and may be the treatment of choice when reconstructive surgery is required.