Femoral resurfacing in young patients with hematologic cancer and osteonecrosis.
Resurfacing hemiarthroplasties were performed to treat advanced osteonecrosis of 20 femoral heads in 14 patients (median age, 19.8 years; range, 15.1-27.4 years), treated for hematologic cancer in childhood or adolescence. Seven hips in five patients were revised to total hip arthroplasties (THA) because of pain; three of these showed radiographic loosening of the femoral head resurfacing component. The median time from resurfacing to revision was 2.4 years (range, 0.9-4.8 years). Marginal Cox-regression analysis, adjusting for correlations owing to bilateral involvement, showed positive association of revision-free survival of the prosthesis with patient's age; time from resurfacing to the end of anticancer therapy, end of glucocorticosteroid therapy; percentage of joint space at the last radiograph; and size of the lesion has a negative association with revision-free survival. Because of this study's exploratory nature, p values were not adjusted for the number of statistical comparisons. Among 14 patients, the probability of not requiring resurfacing prosthesis revision was 66% (SE, +/-15%; 95% CI, 44%-100%) at 3 years. Osteonecrosis of the femoral head in young patients treated for hematologic cancer in childhood or adolescence poses a serious challenge to the orthopaedic surgeon. The data of this preliminary study suggest that in selected patients resurfacing hemiarthroplasty may delay the need for THA for 3-7 years.


METHODS
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Karimova
Evguenia J
EJ
Department of Radiological Sciences, Division of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA.
Rai
Shesh N
SN
Wu
Jianrong
J
Britton
Lunetha
L
Kaste
Sue C
SC
Neel
Michael D
MD
D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D005269:Femur / Q000601:surgery*; D005271:Femur Head Necrosis / Q000150:complications* / Q000601:surgery*; D019337:Hematologic Neoplasms / Q000150:complications*; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma; D011475:Prosthesis Failure; D016059:Range of Motion, Articular; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult