Cementoplasty in the Treatment of Avascular Necrosis of the Hip

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 1, 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 3 AVN and 68% with stage 2 AVN 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 Ill 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. (First Release Dec 15 2008; J Rheumatol 2009;36:385-9; doi:10.3899/jrheum.080363)