Cementless Hip Arthroplasty in Patients with Subchondral Insufficiency Fracture of the Femoral Head

Abstract

Background: Subchondral insufficiency fracture of the femoral head (SIFFH) occurs in elderly patients and might be confused with osteonecrosis of the femoral head (ONFH). Subchondral insufficiency fracture of the femoral head is an insufficiency fracture at the dome of the femoral head and has been known to be associated with osteoporosis, hip dysplasia, and posterior pelvic tilt. This study's aims were to evaluate (1) surgical complications, (2) radiological changes, (3) clinical results, and (4) survivorship of THA in patients with SIFFH. Methods: From November 2010 to June 2017, 21 patients (23 hips); 5 men (5 hips) and 16 women (18 hips) underwent cementless THA due to SIFFH at our institution. Their mean age was 71.9 years (range, 57 to 86) at the time of surgery, and mean T-score was -2.2 (range, -4.2 to 0.2). The mean lateral center-edge angle, abduction, and anteversion of the acetabulum were 29.9 degrees (range, 14.8 degrees to 47.5 degrees), 38.5 degrees (range, 31 degrees to 45 degrees), and 20.0 degrees (range, 12 degrees to 25 degrees), respectively. The mean pelvic incidence, lumbar kyphotic angle and posterior pelvic tilt were 56.4 degrees (range, 39 degrees to 79 degrees), 14.7 degrees (range, -34 degrees to 43 degrees), and 13.0 degrees (range, 3 degrees to 34 degrees), respectively. Results: An intraoperative calcar crack occurred in 1 hip. The mean anteversion and abduction of cup were 29.0 degrees (range, 17 degrees to 43 degrees) and 43.3 degrees (range, 37 degrees to 50 degrees), respectively. One patient sustained a traumatic posterior hip dislocation 2 weeks after the procedure, and was treated with open reduction. At a mean follow-up of 35.4 months (range, 24 to 79 months), no hip had prosthetic loosening or focal osteolysis. At the latest follow-up, the mean modified Harris hip score was 79.1 (range, 60 to 100) points, and mean UCLA activity score was 4.2 (range, 2 to 7) points. The survivorship was 95.7% (95% CI, 94.9% to 100%) at 6 years. Conclusions: Cementless THA is a favorable treatment option for SIFFH in elderly patients.