Cementoplasty in the treatment of avascular necrosis of the hip.
OBJECTIVE
This retrospective study evaluated the role of percutaneous cementoplasty in the treatment of avascular necrosis (AVN) of the hip in order to postpone or avoid total hip replacement.


METHODS
The study population comprised 40 patients (47 hips) with mean age of 46 +/- 4.7 years and mean body mass index of 26.7 +/- 4.6 kg/m(2). AVN was classified according to the Ficat-Arlet classification as one stage I, 30 stage II, and 16 stage III. The minimum followup was 9 months.


RESULTS
It was found that 74.5% of hips were secondarily operated for total hip replacement a mean of 19.9 +/- 15 months (median 14 mo) after cementoplasty. As well, 94% of patients with stage 3AVN and 68% with stage 2AVN underwent surgery. Twelve hips were not operated, with a mean followup of 39 +/- 19.2 months. Pain decreased by more than 80% after cementoplasty in two-thirds of patients, but the mean pain-free interval was only 8.1 +/- 6.6 months (median 5 mo). Nineteen of the 29 working patients were able to transiently return to work. The outcome was more unfavorable with radiological stage III AVN, joint effusion, and/or a double-line sign around the lesions on magnetic resonance images.


CONCLUSIONS
Despite early relief of pain, the results of the cementoplasty technique were disappointing, with need for arthroplasty surgery in most cases within 2 years. Alternative percutaneous techniques using different filler materials with osteoinductive properties should be evaluated in further studies.
Reuter
Nicolas
N
Service de Rhumatologie, INSERM U890, CHU de Saint-Etienne, 25 Boulevard Pasteur, 42055 Saint-Etienne Cedex 2, France.
Romier
Alban
A
Hambourg
Zephir
Z
Palmieri
Frédéric
F
Fayet
Dominique
D
Pallot-Prades
Béatrice
B
Collet
Philippe
P
Fessy
Michel-Henry
MH
Farizon
Frédéric
F
Barral
Fabrice G
FG
Thomas
Thierry
T
D000203:Activities of Daily Living; D000328:Adult; D018771:Arthralgia / Q000209:etiology / Q000601:surgery; D001843:Bone Cements / Q000627:therapeutic use*; D015984:Causality; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005270:Femur Head / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D001843:Bone Cements