Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2024 | Osteonecrosis of the Femoral Head | Research article

Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study

Authors: Tianyu Wang, Dongwei Wu, Chengsi Li, Xinqun Cheng, Zhenbang Yang, Yingze Zhang, Yanbin Zhu

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Background

No large cohort study has evaluated the surgical outcomes of THA between different stages of ONFH patients. This study aimed to compare the surgical outcomes of ONFH patients who underwent THA in ARCO stage III versus IV, in terms of operative parameters, one-year hip function assessments and postoperative at least five-year complications, to inform optimized management of ONFH.

Method

From our prospectively collected database, 876 patients undergoing THA between October 2014 and April 2017 were analyzed and divided into ARCO stage III group (n = 383) and ARCO stage IV group(n = 493). Details of demographics, medical record information, adverse events and clinical scores of both groups were collected and compared. Proper univariate analysis was used for the analysis.

Result

There were no statistically significant differences in baseline characteristics between the two groups. Compared to ARCO stage IV patients, ARCO stage III patients showed a shorter operative time (p < 0.01), less bleeding (p < 0.01), fewer one-year readmissions (p = 0.026) and complications (p = 0.040), and significantly higher HHS (p < 0.01) one year after THA. In addition, ARCO stage IV patients seem more likely to suffer prosthesis dislocation (p = 0.031).

Conclusion

Although ARCO stage IV patients in the study cohorts appeared to suffer more one-year complications, no significant difference was observed at long-term follow-up. Enhanced clinical guidance on preventing early prosthesis dislocation may help improve the prognosis of final-stage ONFH patients.

Cooper C, Steinbuch M, Stevenson R, Miday R, Watts NB. The epidemiology of osteonecrosis: findings from the GPRD and THIN databases in the UK. Osteoporos Int. 2010;21(4):569–77.CrossRefPubMed

Ng MK, Gordon AM, Piuzzi NS, Wong CHJ, Jones LC, Mont MA. Trends in surgical management of osteonecrosis of the femoral head: a 2010 to 2020 nationwide study. J Arthroplasty. 2023;38(7S):S51–7.CrossRefPubMed

Sultan AA, Mohamed N, Samuel LT, Chughtai M, Sodhi N, Krebs VE, Stearns KL, Molloy RM, Mont MA. Classification systems of hip osteonecrosis: an updated review. Int Orthop. 2018;43(5):1089–95.CrossRefPubMed

Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, Drescher W, Gangji V, Goodman SB, Ha YC, et al. The 2019 revised version of association research circulation osseous staging system of osteonecrosis of the femoral head. J Arthroplasty. 2020;35(4):933–40.CrossRefPubMed

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508–19.CrossRefPubMed

Yue J, Guo X, Wang R, Li B, Sun Q, Liu W, Chen J, Zhao F. Reliability and repeatability of 2021 ARCO classification and its guiding significance in treatment of nontraumatic osteonecrosis of the femoral head. BMC Musculoskeletal Disord. 2023;24(1).

Kahlenberg CA, Swarup I, Krell EC, Heinz N, Figgie MP. Causes of revision in young patients undergoing total hip arthroplasty. J Arthroplasty. 2019;34(7):1435–40.CrossRefPubMed

Jo W-L, Lee Y-K, Ha Y-C, Kim T-Y, Koo K-H. Delay of total hip arthroplasty to advanced stage worsens post-operative hip motion in patients with femoral head osteonecrosis. Int Orthop. 2018;42(7):1599–603.CrossRefPubMed

Wang P, Wang C, Meng H, Liu G, Li H, Gao J, Tian H, Peng J. The role of structural deterioration and biomechanical changes of the necrotic lesion in collapse mechanism of osteonecrosis of the femoral head. Orthop Surg. 2022;14(5):831–9.CrossRefPubMedPubMedCentral

10.

Osawa Y, Seki T, Takegami Y, Kasai T, Higuchi Y, Ishiguro N. Do femoral head collapse and the contralateral condition affect patient-reported quality of life and referral pain in patients with osteonecrosis of the femoral head? Int Orthop. 2018;42(7):1463–8.CrossRefPubMed

11.

Yang M, Li X, Chu K, Li Z, Wei C, Yao M, Li H. Comparison of outcomes following total hip arthroplasty between patients diagnosed with association research circulation osseous (ARCO) stage III and stage IV osteonecrosis of the femoral head: a retrospective study of 302 patients. Med Sci Monit. 2023;29.

12.

Zhao D-W, Yu M, Hu K, Wang W, Yang L, Wang B-J, Gao X-H, Guo Y-M, Xu Y-Q, Wei Y-S, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population. Chin Med J. 2015;128(21):2843–50.CrossRefPubMedPubMedCentral

13.

Leunig M, Ganz R. The evolution and concepts of joint-preserving surgery of the hip. Bone Joint J. 2014;96B(1):5–18.CrossRef

14.

Wang T, Gao C, Wu D, Li C, Cheng X, Yang Z, Zhang Y, Zhu Y. One-year unplanned readmission after total hip arthroplasty in patients with osteonecrosis of the femoral head: rate, causes, and risk factors. BMC Musculoskeletal Disord. 2023;24(1).

15.

Wang Z, Zheng Z, Ye P, Tian S, Zhu Y, Chen W, Hou Z, Zhang Q, Zhang Y. Treatment of tibial plateau fractures: a comparison of two different operation strategies with medium-term follow up. J Orthop Transl. 2022;36:1–7.

16.

Zhang K, Zhu Y, Tian Y, Tian M, Li X, Zhang Y. Role of a new age-adjusted D-dimer cutoff value for preoperative deep venous thrombosis exclusion in elderly patients with hip fractures. J. Orthop. Surg. Res. 2021;16(1).

17.

Wang Y, Deng X, Wang Z, Zhu Y, Chen W, Zhang Y. Total hip arthroplasty or hemiarthroplasty for femoral neck fractures in elderly patients with neuromuscular imbalance. Aging Clin Exp Res. 2021;34(11):2825–33.CrossRefPubMed

18.

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form mcgill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240-252.PubMed

19.

Nilsdotter A, Bremander A. Measures of hip function and symptoms: harris hip score (HHS), hip disability and osteoarthritis outcome score (HOOS), oxford hip score (OHS), lequesne index of severity for osteoarthritis of the hip (LISOH), and American Academy of Orthopedic Surgeons (AAOS) hip and knee questionnaire. Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S200-207.PubMed

20.

Rezus E, Tamba BI, Badescu MC, Popescu D, Bratoiu I, Rezus C. Osteonecrosis of the femoral head in patients with hypercoagulability—from pathophysiology to therapeutic implications. Int J Mol Sci. 2021;22(13).

21.

Chen Y, Miao Y, Liu K, Xue F, Zhu B, Zhang C, Li G. Evolutionary course of the femoral head osteonecrosis: histopathological—radiologic characteristics and clinical staging systems. J Orthop Transl. 2022;32:28–40.

22.

Wei W, Tan B, Yan Y, Li W, Zeng X, Chen Q, Wang R, He H, Qin L, Li T, et al. Hip preservation or total hip arthroplasty? A retrospective case-control study of factors influencing arthroplasty decision-making for patients with osteonecrosis of the femoral head in China. Orthop Surg. 2023;15(3):731–9.CrossRefPubMedPubMedCentral

23.

Smith TO, Jepson P, Beswick A, Sands G, Drummond A, Davis ET, Sackley CM. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst. Rev. 2016;2016(7).

24.

Uesugi Y, Sakai T, Seki T, Hayashi S, Nakamura J, Inaba Y, Takahashi D, Sasaki K, Motomura G, Mashima N, et al. Quality of life of patients with osteonecrosis of the femoral head: a multicentre study. Int Orthop. 2018;42(7):1517–25.CrossRefPubMed

25.

Meissner MH, Moneta G, Burnand K, Gloviczki P, Lohr JM, Lurie F, Mattos MA, McLafferty RB, Mozes G, Rutherford RB, et al. The hemodynamics and diagnosis of venous disease. J Vasc Surg. 2007;46(6):S4–24.CrossRef

26.

Hampton SN, Nakonezny PA, Richard HM, Wells JE. Pain catastrophizing, anxiety, and depression in hip pathology. Bone Joint J. 2019;101B(7):800–7.CrossRef

27.

Matsuoka Y, Chen S-B, Hu H, Gao Y-S, He H-Y, Jin D-X, Zhang C-Q. Prevalence of clinical anxiety, clinical depression and associated risk factors in chinese young and middle-aged patients with osteonecrosis of the femoral head. Plos One. 2015;10(3).

28.

Wang Z, Mao X, Guo Z, Zhao R, Feng T, Xiang C. Comparison of walking quality variables between end-stage osteonecrosis of femoral head patients and healthy subjects by a footscan plantar pressure system. Medicina. 2022;59(1).

29.

Sharma V, Morgan PM, Cheng EY. Factors influencing early rehabilitation after THA: a systematic review. Clin Orthop Relat Res. 2009;467(6):1400–11.CrossRefPubMedPubMedCentral

30.

Fortin PR, Penrod JR, Clarke AE, St-Pierre Y, Joseph L, Bélisle P, Liang MH, Ferland D, Phillips CB, Mahomed N, et al. Timing of total joint replacement affects clinical outcomes among patients with osteoarthritis of the hip or knee. Arthritis Rheum. 2002;46(12):3327–30.CrossRefPubMed

31.

Judd DL, Dennis DA, Thomas AC, Wolfe P, Dayton MR, Stevens-Lapsley JE. Muscle strength and functional recovery during the first year after THA. Clin Orthop Relat Res. 2013;472(2):654–64.CrossRefPubMedCentral

32.

Migliorini F, Maffulli N, Eschweiler J, Tingart M, Baroncini A. Core decompression isolated or combined with bone marrow-derived cell therapies for femoral head osteonecrosis. Expert Opin Biol Ther. 2020;21(3):423–30.CrossRefPubMed

33.

Migliorini F, La Padula G, Oliva F, Torsiello E, Hildebrand F, Maffulli N. Operative management of avascular necrosis of the femoral head in skeletally immature patients: a systematic review. Life. 2022;12(2).

34.

Quaranta M, Miranda L, Oliva F, Aletto C, Maffulli N. Osteotomies for avascular necrosis of the femoral head. Br Med Bull. 2021;137(1):98–111.CrossRefPubMed

35.

Migliorini F, Maffulli N, Baroncini A, Eschweiler J, Tingart M, Betsch M. Prognostic factors in the management of osteonecrosis of the femoral head: a systematic review. Surgeon. 2023;21(2):85–98.CrossRefPubMed

36.

Sadile F, Bernasconi A, Russo S, Maffulli N. Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis. Br Med Bull. 2016;118(1):33–49.CrossRefPubMedPubMedCentral

Title: Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study
Authors: Tianyu Wang
Dongwei Wu
Chengsi Li
Xinqun Cheng
Zhenbang Yang
Yingze Zhang
Yanbin Zhu
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Osteonecrosis of the Femoral Head
Hip-TEP
Hip-TEP
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04617-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study

Abstract

Background

Method

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Application and evaluation of artificial intelligence 3D preoperative planning software in developmental dysplasia of the hip

Failure mechanical properties of lumbar intervertebral disc under high loading rate

Relationship between sarcopenia and fatty liver in middle-aged and elderly patients with type 2 diabetes mellitus

Diagnosis and management of Achilles tendon ailments: the Scottish mist

Intraoperative femurofibular angle combined with tibiofibular angle measurement has fewer correction errors in open-wedge high tibial osteotomy

Clinical and ultrasound features of 46 children with suppurative osteoarthritis: experience from two centers