title: Hemi-resurfacing versus total resurfacing for osteonecrosis of the femoral head.
abstract: OBJECTIVE
  To compare mid-term outcomes of hemi-resurfacing arthroplasty (HRA) and total resurfacing arthroplasty (TRA).
  
  
  METHODS
  Seven men and 5 women (16 hips) aged 33 to 72 (mean, 50) years underwent HRA, whereas 7 men and 3 women (16 hips) aged 23 to 52 (mean, 40) years underwent metal-on-metal TRA; all were for osteonecrosis of the femoral head. In the HRA and TRA groups respectively, 10 and 8 hips were steroid-induced, whereas 6 and 8 hips were related to alcohol abuse. Surgery for 12 and 4 hips entailed the posterolateral approach, whereas 4 and 12 hips entailed the Hardinge approach. Usually, HRA was performed for early stages of the disease, and TRA for more advanced stages. 12 and 6 hips were classified as JOA stages 1 to 3A, whereas 4 and 10 hips as stages 3B to 4. All the hips were JOA types C1 or C2.
  
  
  RESULTS
  In the HRA and TRA groups respectively, the mean follow-up period were 6.5 and 5.5 years. The mean total JOA hip scores were 57 and 54 preoperatively, 93 and 97 at one year, and 84 and 96 at the final follow-up (p<0.01). The higher score in the TRA patients was mainly attributed to improvement in the pain score. In the HRA group, 12 hips developed groin pain or groin discomfort while walking, though only 4 of them showed apparent joint-space narrowing. Five patients underwent revision surgeries (conversion to total hip arthroplasty) owing to a femoral neck fracture, acetabular protrusio, osteoarthritic change, and severe groin pain. Patients having TRA had no revision surgery and did not complain of groin pain. Implants in both groups were radiographically stable.
  
  
  CONCLUSIONS
  TRA were superior to HRA in terms of pain relief and implant survival, even though the former procedure was used for more advanced cases.
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. tamonkabata@aol.com
authors.forename: Tamon
authors.initials: T
authors.lastname: Kabata
authors.forename: Toru
authors.initials: T
authors.lastname: Maeda
authors.forename: Kazunori
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hironori
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Kajino
authors.forename: Takeshi
authors.initials: T
authors.lastname: Horii
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Yagishita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome