Outcomes of total hip arthroplasty for osteonecrosis of the hip: systematic review and meta-analysis

Background Total hip arthroplasty is commonly used for treatment of osteonecrosis of the femoral head. We systematically reviewed the available literature to define the outcomes. Methods A total of 3495 hips were available for analysis with an average patient age of 44.9 years and average follow-up of 7.4 years. Results The outcomes for all cohorts revealed a mean postoperative Harris hip score of 85.4 points (6.7 years), revision rate of 14.4% (7.1 years), and "good'' outcome rate of 78.8% (6.5 years). Cohorts with longer than 15 years of follow-up had a mean 22.5% revision rate and 35.1% "poor'' outcome rate. Sickle cell disease, alcohol, and traumatic causes for osteonecrosis increased risks for unfavorable outcomes. Cemented fixation was associated with a greater number of unfavorable outcomes compared with the cementless group [cemented fixation: mean postoperative Harris hip score of 85.2 points (7.9 years), revision rate of 19.1% (8.1 years), and good outcome rate of 67.3% (6.1 years); cementless fixation: mean postoperative Harris hip score of 90.6 points (6.8 years), revision rate of 11.4% (6.3 years), and good outcome rate of 82.5% (6.3 years)]. Conclusions We found acceptable and sustainable outcomes for total hip arthroplasty for hip osteonecrosis. Specific risk factors associated with osteonecrosis increased the risk for unfavorable outcomes.