The results of treatment of posttraumatic avascular necrosis of the femoral head in young adults: report of 31 patients.
A series of 31 adult patients less than 42 years of age who were treated for avascular necrosis (AVN) following a healed femoral neck fracture were followed for an average of 14.6 years, and the results of their treatment were analyzed.  The average age at fracture was 26.3 years (range:  12.2 to 41.4 years).  The mechanism of injury was a motor vehicle accident in 18 and a fall in 13.  Sixteen patients had multiple injuries.  The average time from fracture to diagnosis of AVN was 19.1 months.  The management of AVN included one or a combination of the following:  non-weightbearing ambulation, decompression and bone grafting, electrical stimulation, femoral osteotomy, cup arthroplasty, resurface arthroplasty, arthrodesis, hemiarthroplasty, and total hip arthroplasty (THA).  The average number of hip operations after initial fracture treatment was 2.9 per patient (range:  0-7).  Current follow-up was possible in 97% (30 out of 31) of the patients.  THA was performed either primarily or following other treatment in 23 patients at an average age of 31.9 years (range:  16.9-55.3 years).  The survivorship of these THAs was 89% at five years and 49% at ten years. Revisions have been done for aseptic loosening of cemented components with the exception of two infections and one loose metal-on-metal press-fit THA.  The results of this study indicate that total hip arthroplasty has a high long-term failure rate in this population, and alternate treatment should be considered in order to improve the long-term results.
Oregon Health Sciences University, Portland.
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Rubinstein
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Beals
D000293:Adolescent; D000328:Adult; D001174:Arthrodesis; D002648:Child; D004434:Early Ambulation; D004599:Electric Stimulation Therapy; D005260:Female; D005265:Femoral Neck Fractures / Q000503:physiopathology; D005271:Femur Head Necrosis / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011475:Prosthesis Failure; D012086:Reoperation; D016896:Treatment Outcome