Cementoplasty in the treatment of avascular necrosis of the hip

J Rheumatol. 2009 Feb;36(2):385-9. doi: 10.3899/jrheum.080363.

Abstract

Objective: This retrospective study evaluated the role of percutaneous cementoplasty in the treatment of avascular necrosis (AVN) of the hip in order to postpone or avoid total hip replacement.

Methods: The study population comprised 40 patients (47 hips) with mean age of 46 +/- 4.7 years and mean body mass index of 26.7 +/- 4.6 kg/m(2). AVN was classified according to the Ficat-Arlet classification as one stage I, 30 stage II, and 16 stage III. The minimum followup was 9 months.

Results: It was found that 74.5% of hips were secondarily operated for total hip replacement a mean of 19.9 +/- 15 months (median 14 mo) after cementoplasty. As well, 94% of patients with stage 3AVN and 68% with stage 2AVN underwent surgery. Twelve hips were not operated, with a mean followup of 39 +/- 19.2 months. Pain decreased by more than 80% after cementoplasty in two-thirds of patients, but the mean pain-free interval was only 8.1 +/- 6.6 months (median 5 mo). Nineteen of the 29 working patients were able to transiently return to work. The outcome was more unfavorable with radiological stage III AVN, joint effusion, and/or a double-line sign around the lesions on magnetic resonance images.

Conclusion: Despite early relief of pain, the results of the cementoplasty technique were disappointing, with need for arthroplasty surgery in most cases within 2 years. Alternative percutaneous techniques using different filler materials with osteoinductive properties should be evaluated in further studies.

MeSH terms

  • Activities of Daily Living
  • Adult
  • Arthralgia / etiology
  • Arthralgia / surgery
  • Bone Cements / therapeutic use*
  • Causality
  • Disability Evaluation
  • Disease Progression
  • Female
  • Femur Head / pathology
  • Femur Head / radiation effects
  • Femur Head / surgery
  • Femur Head Necrosis / diagnostic imaging
  • Femur Head Necrosis / pathology
  • Femur Head Necrosis / surgery*
  • Hip Joint / diagnostic imaging
  • Hip Joint / pathology
  • Hip Joint / surgery*
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods*
  • Orthopedic Procedures / methods*
  • Outcome Assessment, Health Care
  • Plastic Surgery Procedures / methods*
  • Postoperative Complications / etiology
  • Postoperative Complications / pathology
  • Postoperative Complications / physiopathology
  • Radiography
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Substances

  • Bone Cements