title: Total hip arthroplasty in steroid-induced osteonecrosis: early functional and radiological outcomes.
abstract: BACKGROUND
  The proportion of total hip arhtoplasties (THAs) associated with corticosteroid use is uncertain, and the mechanisms of corticosteroid-induced osteonecrosis remain unknown. We sought to evaluate the clinical and radiographic outcomes, complications and satisfaction with THA among patients with corticosteroid-induced osteonecrosis.
  
  
  METHODS
  We retrospectively assessed functional outcome at a minimum 1-year follow-up using the Western Ontario and MacMaster Universities Arthritis Index (WOMAC); Oxford Hip Score; Short Form (SF)-12; University of California, Los Angeles (UCLA) Activity; and patient satisfaction scores.
  
  
  RESULTS
  We included 31 patients (35 hips). The average follow-up was 20 (range 12- 55) months, and the average age at surgery was 47 (range 19-78) years. At follow-up, patients showed significant improvement in all 4 components of the WOMAC (means: function 84, stiffness 75, pain 86, global 84), Oxford-12 (mean 83) and SF-12 (means: mental 40 and physical 48) scores. However, there was no significant improvement in the UCLA Activity scores. Mean patient satisfaction scores were good for pain relief (86), function (80), recreation (77.5) and overall results of surgery (86). Radiographic review at follow-up showed that all components were well fixed with no evidence of loosening. The complication rate was high (17%), with 6 complications in 5 patients (6 of 35 hips). Four patients (4 of 35 hips; 11%) required reoperations.
  
  
  CONCLUSIONS
  Total hip arthroplasty in patients with corticosteroid-induced osteonecrosis of the femoral head is successful in reducing pain and improving function; however, the rate of complications and reoperation is high.
authors.affiliation: Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Vancouver, Canada. dr.waelrahman@gmail.com
authors.forename: Wael A
authors.initials: WA
authors.lastname: Rahman
authors.forename: Donald S
authors.initials: DS
authors.lastname: Garbuz
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Masri
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011859:Radiography; D020127:Recovery of Function; D012107:Research Design; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones