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Original ArticleOpen Access
Reliability and Clinical Outcomes of Preoperative Evaluations in Modern Total Hip Resurfacing and Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head
Larbpaiboonpong V 
,
Turajane T ,
Sisayanarane T
,
Turajane T ,
Sisayanarane T Background: Modern total hip resurfacing has been associated with excellent intermediate outcome in
patients with osteonecrosis hip who are under 60 years. , Up to 30-50% necrosis area in X-ray and MRI are
theoretically acceptable to perform total hip resurfacing. However, both of plain X-ray and MRI still are
uncertain information to precisely support decision making for either hip resurfacing or hip arthroplasty.
Objective: Double setup operations (resurfacing or arthroplasty) were developed (i) to evaluate the reliability
of preoperative evaluation based on plain X-ray and MRI comparing to the intra-operative finding after the
completion of bone surface cut in hip resurfacing femoral procedure and (ii) to examine the early outcome for
this double set up techniques.
Material and Method: Between September 2004 to December 2008, 45 osteonecrosis hips (40 patients) were
managed with double setup in which was either total hip resurfacing or total hip arthroplasty. The final intraoperative
decisions were performed and then the comparison of the reliability of pre-operative evaluation
was done. Outcomes assessment was examined based on Harris Hip score, Oxford hip score, university of
California Los Angeles (UCLA) activity score, Short form-12 score, complications, and radiographic alignment
including radiolucencies.
Results: Twenty-five hips finally were performed with total hip resurfacing and the rest twenty hips were
performed with total hip arthroplasty. Preoperative evaluation plans were unchanged from arthroplasty to
resurfacing by intra-operative evaluation in 20 of 33 hips, representing the approximate reliability 61%. All
13 cases whose preoperative plans were changed had preoperative radiographic necrotic head involvement
more than 50%, cystic change > 1.5 cm in size, superior head collapse more than 8 mm. The follow-up mean
time was 28.6 months (5-50). All postoperative functional scores at the last follow-up (HHS, Oxford, UCLA,
SF12) were significantly improved from preoperative functional score (p < 0.001). Pulmonary embolism was
found in one patient with sickle cells induced osteonecrosis hip and no further complication after recovery.
There was no postoperative infection, fracture neck of femur, DVT, nerve palsy, radiographic change.
Conclusion: Double setup operations were found efficacious to provide reliable information for the
resurfacing surgeons to avoiding the too early total hip arthroplasty in the young patients. As a result, the
patients can preserve their femoral heads at best.
Keywords: Osteonecrosis, Hip resurfacing, Arthroplasty, Avascular necroris, Surgical procedures
patients with osteonecrosis hip who are under 60 years. , Up to 30-50% necrosis area in X-ray and MRI are
theoretically acceptable to perform total hip resurfacing. However, both of plain X-ray and MRI still are
uncertain information to precisely support decision making for either hip resurfacing or hip arthroplasty.
Objective: Double setup operations (resurfacing or arthroplasty) were developed (i) to evaluate the reliability
of preoperative evaluation based on plain X-ray and MRI comparing to the intra-operative finding after the
completion of bone surface cut in hip resurfacing femoral procedure and (ii) to examine the early outcome for
this double set up techniques.
Material and Method: Between September 2004 to December 2008, 45 osteonecrosis hips (40 patients) were
managed with double setup in which was either total hip resurfacing or total hip arthroplasty. The final intraoperative
decisions were performed and then the comparison of the reliability of pre-operative evaluation
was done. Outcomes assessment was examined based on Harris Hip score, Oxford hip score, university of
California Los Angeles (UCLA) activity score, Short form-12 score, complications, and radiographic alignment
including radiolucencies.
Results: Twenty-five hips finally were performed with total hip resurfacing and the rest twenty hips were
performed with total hip arthroplasty. Preoperative evaluation plans were unchanged from arthroplasty to
resurfacing by intra-operative evaluation in 20 of 33 hips, representing the approximate reliability 61%. All
13 cases whose preoperative plans were changed had preoperative radiographic necrotic head involvement
more than 50%, cystic change > 1.5 cm in size, superior head collapse more than 8 mm. The follow-up mean
time was 28.6 months (5-50). All postoperative functional scores at the last follow-up (HHS, Oxford, UCLA,
SF12) were significantly improved from preoperative functional score (p < 0.001). Pulmonary embolism was
found in one patient with sickle cells induced osteonecrosis hip and no further complication after recovery.
There was no postoperative infection, fracture neck of femur, DVT, nerve palsy, radiographic change.
Conclusion: Double setup operations were found efficacious to provide reliable information for the
resurfacing surgeons to avoiding the too early total hip arthroplasty in the young patients. As a result, the
patients can preserve their femoral heads at best.
Keywords: Osteonecrosis, Hip resurfacing, Arthroplasty, Avascular necroris, Surgical procedures
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