Editorial Comment

Arthroplasty

Surface replacement hemiarthroplasty offers a minimally destructive procedure, although some authors think it serves as a bridge to later total hip arthroplasty. Siguier and colleagues proposed a cemented partial surface replacement, where the prosthesis was designed to replace that portion of the femoral head’s surface affected by the osteonecrosis and to restore the normal femoral head’s sphericity. The results indicate that a cemented partial resurface replacement of the femoral head provides a solution for the treatment of young patients with Stage III and less extensive Stage IV osteonecrosis of the femoral head. Of the 37 prostheses applied, nine failures were encountered and the authors report that revision to total hip arthroplasty was straightforward.

Although retention of the femoral head is accepted as the goal of early treatment, methods for treating osteonecrosis of the femoral head remain controversial. Once end-stage osteonecrosis has developed with collapse of the femoral head, total hip arthroplasty has become the accepted means for surgical management of pain and restoration of function. ¹⁶ Although the surgical options for patients with late osteonecrosis are limited, the inherent characteristics of the patient with advanced disease (age, increased activity, underlying disease, poor bone quality) present a difficult challenge to the surgeon and result in a significant risk for failure. Xenakis and colleagues assessed 36 total hip arthroplasties with a followup of 10 to 15 years. The high success rate in terms of survivability (93.4%) at long-term followup was attributed to the use of a cementless arthroplasty, because cemented arthroplasty is subject to early aseptic loosening and failure, and the patients selected in their study were older as a result of a delayed decision to perform the procedure. Patients had clinical and radiographic signs of osteoarthritis for more than 6 years.