One-stage hip arthroplasty and bone grafting for bilateral femoral head osteonecrosis.
One-stage hip arthroplasty and contralateral core decompression with bone grafting were performed for 30 patients with bilateral femoral head osteonecrosis between April 2002 and June 2005. The treatment course, clinical and radiographic outcomes, and medical costs were compared with another 30 age-, gender-, etiology-, and disease extent-matched patients undergoing two-stage treatment during the same period. The two groups had similar clinical data and few complications. Total hospital stay and associated costs were reduced for patients who had one-stage treatment. These patients also returned to work faster (6.0 versus 10.8 months). At an average followup of 46 months, progression to greater than 2 mm of collapse of the salvaged femoral head was observed in seven patients (23%) who had one-stage treatment and 14 patients (47%) who had two-stage treatment. Conversion to hip arthroplasty was performed in five patients (17%) in the one-stage group and 12 patients (40%) in the two-stage group. A special group of patients with bilateral osteonecrosis of the femoral head seemed to benefit from one-stage hip arthroplasty and contralateral core decompression with bone grafting and had better survival of the salvaged femoral head. One-stage hip arthroplasty and core decompression with bone grafting proved to be a cost-effective method that did not increase perioperative morbidity.


METHODS
Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Shih
Lih-Yuann
LY
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing St, Kweishan, 333, Taoyuan, Taiwan, ROC.
Wong
Yon-Cheong
YC
Shih
Hsin-Nung
HN
D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000379:methods*; D016063:Blood Loss, Surgical; D016025:Bone Transplantation / Q000191:economics / Q000379:methods; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D018709:Statistics, Nonparametric; D016896:Treatment Outcome