A comparative study of bipolar hemi-arthroplasty and total hip joint replacement for the treatment of grade III Osteonecrosis of femoral head

Mankar SH, Dwidmuthe SC, Mohammad Faizan


Total hip arthroplasty (THA) is considered as gold standard for treatment of advanced (Grade III & IV Ficat Arlet) osteonecrosis (AVN) of femoral head. We conducted this prospective study to compare results of bipolar hemi-arthroplasty against total hip arthroplasty in patients with grade III Avascular necrosis of femoral head.36 patients with Grade III Osteonecrosis of femoral head were included in this study. At an average 4 years, 16 patients with average age of 44 years (21-56 years) in THA group and 15 patients with average age of 43 years (28-45 years) in BHA group were available for analysis. The average increase in HHS in THA group was 47.3points (S.D. - 4.8) and 38.9 (S.D. - 2.7) in BHA group with t value 5.4(P-0.0001). All the patients in BHA group had fair to good results. In THA group eight excellent, five good and one had fair to poor result after the surgery Fair to poor results were seen in one patient in THA with dislocation in early postoperative period. BHA group had one case of superficial infection at operative site. Very higher incidence of groin pain and activity limitation was seen in patients with BHA. THA is a better surgical option for treatment of grade III osteonecrosis of femoral head. Because of risk of groin pain, loosening, proximal migration, progression of disease and compromised function after BHA, we do not recommend it in patients with grade III Osteonecrosis.
Keywords: Avascular necrosis, bipolar hemi-arthroplasty, total hip arthroplasty.

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