Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Research Article

Vol. 10 No. 1 (2007)

Short Term Clinical Outcome of a Porous Tantalum Implant for the Treatment of Advanced Osteonecrosis of the Femoral Head

  • Melissa Nadeau
  • Chantal Séguin
  • John S Theodoropoulos
  • Edward J Harvey
DOI
https://doi.org/10.26443/mjm.v10i1.462
Submitted
November 1, 2020
Published
2020-12-01

Abstract

Purpose of the study: Osteonecrosis of the hip mostly affects young individuals and often
progresses to a debilitating disease. Several treatment modalities exist, but none are completely satisfactory. This study evaluates the clinical outcome of patients treated with core decompression and insertion of a porous tantalum implant in the femoral head. This procedure is similar to commonly performed procedures, but has the additional advantages of providing structural support to the necrotic femoral head while having no donor-site morbidity. Methods: We evaluated 15 patients with 18 osteonecrotic hips with Steinberg stage III (3 hips) and IV (15 hips) disease. The mean age of the patients was 42 years-old (eldest 66), and the mean time for follow-up was 23 months. The outcome measure was hip function, evaluated with the Harris hip score, and the end point was total hip arthroplasty, or referral for this procedure. Results: The success rate at twelve months postoperatively was 77.8%, and the overall success rate was 44.5%. Failures occurred at a mean time of 11.7 months, and one complication, a periprosthetic fracture, occurred 4 months postoperatively. On average, patients who did well improved their Harris hip scores by 21.7 points, and patients who eventually required arthroplasty decreased their scores by 14 points. Conlusions: Core decompression with porous tantalum implants showed encouraging success rates and early clinical results in patients with advanced stage osteonecrosis, but further larger scale studies are required to identify the population best suited for this procedure.

References

  1. Collaborative Osteonecrosis Group. Symptomatic Multifocal Osteonecrosis: A Multicenter Study. Clinical Orthopaedics & Related Research 1999; 369:312-26.
  2. Scully SP, Aaron RK, Urbaniak JR. Survival Analysis of Hips Treated with Core Decompression or Vascularized Fibular Grafting because of Avascular Necrosis. J Bone Joint Surg Am. 1998; 80(9):1270-5.
  3. Mont MA, Carbone JJ, Fairbank AC. Core Decompression versus Nonoperative Management for Osteonecrosis of the Hip. Clin Orthop Relat Res. 1996; 324:169-78.
  4. Mont MA, Jones LC, Hungerford DS. Nontraumatic Osteonecrosis of the Femoral Head: Ten Years Later. J Bone Joint Surg Am. 2006; 88(5):1117-32.
  5. Chernetsky SG, Mont MA, LaPorte DM, et al. Pathologic Features in Steroid and Nonsteroid Associated Osteonecrosis. Clin Orthop Relat Res. 1999; 368:149-61.
  6. Inoue S, Horii M, Asano T, et al. Risk Ractors for Nontraumatic Osteonecrosis of the Femoral Head after Renal Transplantation. J Orthop Sci. 2003; 8(6):751-6.
  7. Blacksin MF, Kloser PC, Simon J. Avascular Necrosis of Bone in Human Immunodeficiency virus Infected Patients. Clin Imaging 1999; 23(5):314-8.
  8. Mont MA, Hungerford DS. Non-traumatic Avascular Necrosis of the Femoral Head. J Bone Joint Surg Am. 1995; 77(3):459- 74.
  9. Ohzono K, Saito M,Takaoka K, et al. Natural History of Nontraumatic Avascular Necrosis of the Femoral Head. J Bone Joint Surg Br. 1991; 73(1):68-72.
  10. Aaron RK et al. The conservative treatment of osteonecrosis of the femoral head. A Comparison of Core Decompression and Pulsing Electromagnetic Fields. Clin Orthop Relat Res. 1989; 246:209-18.
  11. Bassett CA, Schink-Ascani M, Lewis SM. Effects of Pulsed Electromagnetic Fields on Steinberg Ratings of Femoral Head Osteonecrosis. Clin Orthop Relat Res.1989; 246:172-85.
  12. Tang CL, Mahoney JL, McKee MD, et al. Donor Site Morbidity Following Vascularized Fibular Grafting. Microsurgery 1998; 18(6):383-6.
  13. Steinberg ME, Larcom PG, Strafford B, et al. Core Decompression with Bone Gafting for Osteonecrosis of the Femoral Head. Clin Orthop Relat Res. 2001; (386):71-8.
  14. Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH. Vascularized Compared with Nonvascularized Fibular Graftsfor Large Osteonecrotic Lesions of the Femoral Head. J Bone Joint Surg Am. 2005; 87(9):2012-8.
  15. Mont MA, Etienne G, Ragland PS. Outcome of Nonvascularized Bone grafting for Osteonecrosis of the Femoral Head. Clin Orthop Relat Res. 2003; (417):84-92.
  16. H. Kato, T. Nakamura, S. Nishiguchi, Y. Matsusue, M. Kobayashi and T. Miyazaki et al., Bonding of Alkali- and Heat-Treated Tantalum Implants to Bone. J Biomed Mater Res. 2000;53(1):28-35.
  17. Bobyn JD, Poggie RA,Krygier JJ. Clinical Validation of a Structural Porous Tantalum Biomaterial for Adult Reconstruction. J Bone Joint Surg Am. 2004; 86-A Suppl 2:123-9.
  18. L.D. Zardiackas, D.E. Parsell, L.D. Dillon, D.W. Mitchell, L.A. Nunnery and R. Poggie, Structure, Metallurgy, and Mechanical Properties of a Porous Tantalum Foam, J Biomed Mater Res. 2001; 58(2):180-187.
  19. D.A. Shimko, V.F. Shimko, E.A. Sander, K.F. Dickson and E.A. Nauman, Effect of Porosity on the Fluid Flow Characteristics and Mechanical Properties of Tantalum Scaffolds, J Biomed Mater Res B Appl Biomater. 2005; 73(2):315-324.
  20. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ. Characteristics of Bone Ingrowth and Interface Mechanics of a New Porous Tantalum Biomaterial. J Bone Joint Surg Br. 1999; 81(5):907-14.
  21. Levine BR, Sporer S, Poggie RA, Della Valle CJ, Jacobs JJ. Experimental and Clinical Performance of Porous Tantalum in Orthopedic Surgery. Biomaterials. 2006; 27(27):4671-81.
  22. Schildhauer TA et al. Bacterial Adherence to Tantalum versus Commonly Used Orthopedic Metallic Implant Materials. J Orthop Trauma. 2006; 20(7):476-84.
  23. Harris WH. Traumatic Arthritis of the Hip After Dislocation and Acetabular Fractures: Treatment by Mold Arthroplasty: an End-result Study Using a New Method of Result Evaluation. J Bone Joint Surg Am. 1969; 51:737-55.
  24. Söderman P, Malchau H. Is the Harris Hip Score System Useful to Study the Outcome of Total Hip Replacement? Clin Orthop Relat Res. 2001; 384:189-97.
  25. Soucacos PN, Beris AE, Malizos K, Koropilias A, Zalavras H, Dailiana Z. Treatment of Avascular Necrosis of the Femoral Head with Vascularized Fibular Transplant. Clin Orthop Relat Res. 2001; (386):120-30.
  26. Sotereanos DG, Plakseychuk AY, Rubash HE. Free Vascularized Fibula Grafting for the Treatment of Osteonecrosis of the Femoral Head. Clin Orthop Relat Res. 1997; (344):243-56.
  27. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of Osteonecrosis of the Femoral Head with Free Vascularized Fibular Grafting. A Long-term Follow-up Study of One Hundred and Three Hips. J Bone Joint Surg Am. 1995; 77(5):681-94.
  28. Tsao AK, Roberson JR, Christie MJ Biomechanical and Clinical Evaluations of a Porous Tantalum Implant for the Treatment of Early-stage Osteonecrosis. J Bone Joint Surg Am. 2005; 87 Suppl 2:22-7.
  29. Veillette CJ, Mehdian H, Schemitsch EH, McKee MD. Survivorship Analysis and Radiographic Outcome Following Tantalum Rod Insertion for Osteonecrosis of the Femoral Head. J Bone Joint Surg Am. 2006; In Press 88 Suppl 3:48-55.
  30. Steinberg ME, Brighton CT, Corces A. Osteonecrosis of the Femoral Head; Results of Core Depression and Grafting with Electrical Stimulation. Clin Orthop. 1989; 249:199–208.

Downloads

Download data is not yet available.