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Osteonecrosis not a predictor of THA revision

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Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty, even when associated with other common risk factors, and total hip arthroplasty revision rates have improved since 1990, according to a study presented by Henning R. Johansson at the SICOT XXV Triennial World Congress 2011.

Johansson and his team noticed a difference in revision rates in older and newer literature. They postulated that osteonecrosis may be a predictor and wanted to find out if revision rates had changed over time.

“There have been numerous reports showing results of THA [total hip arthroplasty] in these patients and older publications show very high revision rates ranging from 37% to 53%,” Johannson said. “However, recently, more promising data has been released which is very good where you have revision rates ranging from 3.8% to 4.8%.”

To test their theory, the researchers pulled articles from Medline and Embase online databases up to the year 2007. They used search terms THA, osteonecrosis and avascular necrosis. They included articles on primary and total hip arthroplasty regardless of fixation technique and with outcomes measured by revision rate. They excluded previously published and revision cases and hemiarthroplasty, bipolar arthroplasty and resurfacing procedures. They found 67 studies with 2,574 patients and 3,258 THAs for osteonecrosis of the femoral head. Mean age was 44 years.

The investigators quantified revision rates at 30% in all patients in all of the articles. However, they found a discrepancy between generations. Before 1990, revision rates were 17%, whereas revision rates were 3% after 1990.

“Our revision rate in the new group was 3% and that is pretty similar to the survivorship of THA compared to the national registries,” Johansson said.

The researchers stratified risk factors associated with revision from highest to lowest. They found lower revision rates in patients diagnosed with idiopathic disease, systemic lupus erythematosus and after heart transplant and higher revision rates in patients with sickle cell disease, Gaucher disease or renal failure or renal transplant.

“We strongly believe the revision rates in the reviewed generations of THAs are similar to the general population,” Johansson said. “However, there are some risk factors that appear to portend worse outcomes like Gaucher, renal failure, transplants or sickle cell disease. However, most of the patients, approximately 82%, do not have these associated risk factors that put them at a higher risk for revision.”

Reference:

• Johansson HR, Zywiel MG, Marker DR, Mont MA. Is osteonecrosis a predictor of poor outcomes in primary total hip arthroplasty? Presented at the SICOT XXV Triennial World Congress 2011. Sept. 6-9. Prague.

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