title: Is bipolar hemiarthroplasty a reliable option for Ficat stage III osteonecrosis of the femoral head? 15- to 24-year follow-up study.
abstract: OBJECTIVE
  The long-term results of a bipolar hemiarthroplasty (BHA) for osteonecrosis (ON) of the femoral head have not been favorable. The causes have been attributed to cup migration and osteolysis or groin pain. The purpose of this study was to analyze the long-term outcomes and the survivorships of bipolar hemiarthroplasty applied to Ficat stage III ON.
  
  
  METHODS
  Between 1985 and 1993, 49 patients (63 hips) underwent cementless BHA for Ficat stage III ON. Of these 49 patients, 43 patients (55 hips) of mean age 42.2 years were available for follow-up review at a mean duration of 20.3 years post operation. Anteroposterior hip serial (including extreme abduction/adduction) radiographs were used to evaluate osteolysis, migration, cartilage wear rate, and the ratio of outer/inner bearing motion (O/I ratio) at the latest follow-up.
  
  
  RESULTS
  The mean Harris hip score improved to 80.8 points at the latest follow-up. Survivorship at 24 years was 79 and 69 % with revision for any reason and development of acetabular osteolysis as the end point. Groin pain was present in 20 (36.4 %) of the 55 hips, and isolated groin pain was not a reason for revision. The patients had revision surgery performed, which showed that the cartilage wear rate was significantly high, and that the O/I ratio was significantly low (p < 0.05).
  
  
  CONCLUSIONS
  Survivorship determined in this study was more favorable than that of previous studies, and exceeded expectation. The BHA for Ficat stage III ON is not reliable option anymore, considering low survival rate and high osteolysis developmental rate.
authors.affiliation: Department of Orthopaedic Surgery, Hanyang University Hospital, Haengdang-dong 17, Seongdong-gu, Seoul 133-792, Korea.
authors.forename: Kyu-Tae
authors.initials: KT
authors.lastname: Hwang
authors.forename: Young-Ho
authors.initials: YH
authors.lastname: Kim
authors.forename: Yee-Suk
authors.initials: YS
authors.lastname: Kim
authors.forename: Il-Yong
authors.initials: IY
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005271:Femur Head Necrosis / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000379:methods*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult