Total hip arthroplasty in the treatment of severe stages of osteonecrosis of the femoral head and osteoarthritis: results and complications

BACKGROUND: Currently, total hip arthroplasty (THA) is the method of choice for the treatment of severe stages of osteonecrosis of the femoral head (OFH) and osteoarthritis (OA) of the hip joint. AIM: to assess the efficacy and complication pattern of THA in late stages of OFH and OA. MATERIALS AND METHODS: The study included 74 patients who underwent primary total hip arthroplasty for OFH (stages 3-4 according to ARCO classification) and for osteoarthritis (OA) stages 3-4 according to Kellgren and Lawrence classification. Group I included 34 patients with stages 3-4 of OFH and Group II included 40 patients with stages 3-4 of OA hip. The groups were comparable in terms of gender composition and the age of the patients. Implantation of endoprosthesis components was performed in all patients using press-fit fixation with a metal-polyethylene articulation. Treatment results were assessed with regard to the incidence of complications and functional results after 3, 6 months, 1 year, and 3 years after THA. RESULTS: In our study, component survival rate after the total hip arthroplasty within 3 years after the implantation was 100%. There were no observations with periprosthetic fracture, periprosthetic infection and aseptic instability of endoprosthesis components in either group. Superficial inflammation of the postoperative wound was detected in 1 patient in the OFH group (2.9%) and in 1 patient with OA (2.5%). Dislocation of the endoprosthesis occurred in 1 patient with OFH; there were no such observations in the OA group. The frequency of peri-implant osteolysis in the ОFH group was 5.8% and was twice lower (2.5%) in patients with OA. There were no significant differences in the dynamics of functional results before and after surgery between the groups (Harris score scale). The average Harris score scale in patients with ОFH was 63 and reached 94 after 3 years. The similar scores in the group with OA were 58 and 94. CONCLUSION: ТHA is a non-alternative method for the treatment of severe hip arthroplasty. Endoprosthesis with cementless components, metal-polyethylene articulation has demonstrated high efficacy as well as a low number of complications among the patients with OFH and OA. We found no significant difference in the results of the total hip arthroplasty in terms of survival rate, postoperative complications and functional outcome in patients with osteonecrosis and patients with osteoarthritis. A longer postoperative monitoring of the patients is advisable which may allow us to identify some differences in treatment outcomes. © Eco-Vector, 2022.