[Cementless total hip arthroplasty in patients with avascular necrosis of the femoral head]. / Femur basi avasküler nekrozu olan hastalarda çimentosuz total kalça artroplastisi.

OBJECTIVES: We assessed the results of cementless total hip arthroplasty in patients with late-stage avascular necrosis of the femoral head. METHODS: Unilateral cementless total hip replacement was performed in 25 patients (19 males, 6 females; mean age 39.6 years; range 26 to 56 years) with avascular necrosis of the femoral head. A cementless acetabular cup with screws was used for the acetabulum with a cementless femoral component. Functional results were evaluated according to the Harris hip score. Radiographically, acetabular and femoral components were evaluated according to the criteria of Lins et al. and Engh et al., respectively. Heterotopic ossification was assessed according to the criteria of Brooker et al. The mean follow-up was 63.9 months (range 48 to 94 months). RESULTS: The mean Harris hip score increased from 41.5 (range 33 to 52) to 87.1 (range 74 to 96) after the treatment (p<0.001). No radiographic loosening was detected in 22 patients (88%). Radiolucent lines were observed in one acetabular and two femoral components, but no secondary interventions were performed as the patients were asymptomatic. Heterotopic ossification was observed in 13 patients, which was grade 1 in eight patients, grade 2 in two patients, and grade 3 in three patients. CONCLUSION: In general, patients who undergo total hip arthroplasty for avascular necrosis of the femoral head are younger and more active compared to those with osteoarthritis, showing a high likelihood of future revision procedures. Our results favor cementless applications as a more appropriate alternative in this patient group.