Impact of implant design on femoral head hemiresurfacing arthroplasty

Two consecutive series of cemented femoral hemiresurfacing arthroplasty for patients with Ficat Stage III and early Stage IV osteonecrosis of the femoral head were studied to identify the impact of design on the clinical and radiographic results. Group I (30 patients, 33 hips) components had a cobalt chrome shell with a tapered inner dimension, no stem, and sizes in 2-mm increments. Group II (37 patients, 51 hips) components differed by adding a proportional stem, increased spherical coverage, and sizes in 1-mm increments. The average age for the patients in both groups was 40 years. Fifty percent of the patients in Group I were men; in 43% of patients osteonecrosis was associated with steroid use and in 21% of patients it was associated with alcohol use. Thirty-three percent of the patients in Group II were men; in 41% of patients osteonecrosis was associated with steroid use and in 17% of patients it was associated with alcohol use. The average followup is 42 months for Group I and 24 months for Group II. Neither group experienced infections, nerve palsies, dislocations, or loosening. In Group I, two patients died of unrelated causes and five patients had reoperations, two for femoral neck fractures, and three for unsatisfactory pain relief. No patients in Group II had femoral neck fractures but three patients had reoperations for unsatisfactory pain relief. The stemmed component in Group II has resulted in an improvement in component position and elimination of femoral neck fractures in this series.