Noncemented Total Hip Arthroplasty for Osteonecrosis of the Femoral Head in Elderly Patients

The results of total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH) in elderly patients (80 years or older) has not been well defined. The purpose of this retrospective study was to evaluate the clinical course of and the results in noncemented THA for ONFH in elderly patients. Between 1998 and 2007, one hundred seven consecutive hips with ONFH in 103 patients were evaluated. The causes of ONFH were traumatic in 46 (43%) hips and nontraumatic in 61 (57%) hips. All hips were treated with noncemented THA. Average follow-up was 72 months (range, 60-144 months). The functional results improved to statistical significance after THA. However, no significant differences existed between 6 months, 1 year, and 5 years postoperatively. Nine (8.4%) postoperative complications occurred in these 107 hips, including 1 stem loosening, 1 liner wearing, 4 postoperative infections, 2 postoperative dislocations, and 1 pulmonary embolism. Fifteen (14.6%) deaths occurred during follow-up. The progression of ONFH in elderly patients was so rapid and the result of core decompression was so poor that a salvage procedure seemed to have no role in the treatment. Harris Hip Score, Short Form 36 physical function score, and Western Ontario and McMaster Universities Osteoarthritis Index scores significantly improved after noncemented THA. Ninety-two hips had a complete follow-up, and the survivorship of prosthesis was 95% (88/92) with minimal 5-year follow-up. Noncemented THA was effective in the treatment of ONFH in this group of patients.