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Update on Osteonecrosis and Hip Joint Replacement

Alcohol abuse can cause bone death in the hip joint among adults of all ages, especially younger adults. The term for this condition is osteonecrosis. It occurs when the top of the hipbone loses its blood supply. Other factors such as steroid use and fractures can also cause this problem.

Some bones are at greater risk for osteonecrosis than others. One of these is the thighbone (femur). The blood supply to the head on top of the femur (the femoral head) is fairly small. Changes from too much alcohol, drugs, or fractures can reduce the blood flow even more.

Without enough blood, the bone cells start to die. The femoral head may collapse. When this happens, a hip joint replacement (called arthroplasty) may be needed.

In the past, total hip arthroplasty (THA) often failed in patients with osteonecrosis. In fact, there's a higher rate of implant failure for patients with osteonecrosis than any other hip disorder. The stem that holds the new femoral head is placed down into the femur, and it often comes loose.

This study reviews this problem and updates success with new implant designs and better surgery methods. Two groups of patients received hip implants. Anyone with a single hip replacement had a cementless stem. Patients who had both hips replaced got one with cement and one without.

In all cases, patients were soon able to walk without a limp and without walking aids or support. Activities such as putting on shoes, cutting toenails, and using stairs were much improved. Results were the same for implants that were put in place with or without cement.

The authors conclude that patients with alcohol- or steroid-induced osteonecrosis have a better outcome with the newer joint replacements. Better implant design and improved surgical and cementing techniques seem to be the main reasons for the good results.

References: Young-Hoo Kim, MD, et al. Contemporary Total Hip Arthroplasty with and without Cement in Patients with Osteonecrosis of the Femoral Head. In The Journal of Bone and Joint Surgery. April 2003. Vol. 85-A. No. 4. Pp. 675-681.

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