Hip Resurfacing And Total Hip Replacement In The Treatment Of Avascular Necrosis Of The Efficacy Comparison

Avascular necrosis of the femoral head (ANFH) is due to different causes which destroy the femoral head blood supply to the final result, is a common clinical disease. The causes of ANFH can be divided into two categories:one is traumatic avascular necrosis; the other is non-traumatic avascular necrosis, alcohol and receiving hormone therapy is the most common risk factor.The main disease age of ANFH is 30 to 50 years old, male predominance. ANFH is a kind of refractory disease in orthopedic, although various of treatment that preserve the femoral head has received encouraging effect, there are still many femoral heads will progress to collapse, hip joint function is severely damaged. The reasons include inappropriate timing of treatment and medical technology, irregular treatment and large necrosis area, etc. Therefore, the artificial joint replacement surgery plays an important role in the treatment of advanced (ARCOⅢ(B, C) andⅣ) ANFH. The most commonly used type of prosthesis is metal-on-metal surface replacement and total hip replacement (bone cement, biological and mixed type).Objective:Evaluate the clinical effect of total hip surface replacement and total hip replacement in ANFH.Methods:The 26 ANFH patients, selected from October 2007 to December 2008, who received surgical treatment in Dong Zhi Men Hospital,22 cases were followed up for 12 months, compared with Harris hip function scores.26 cases of ANFH (ARCOⅢ(B, C) andⅣ) patients had been treated with artificial joint prosthesis, in which,16 patients with total hip surface replacement (THSR),10 patients with total hip replacement (THR).Results:A total of 26 patients,22 patients were followed up for 12 months, no wound infection, periprosthetic fracture and no deaths. The mean preoperative Harris hip function score of 22 patients is 44.7 points (36 to 55 points), after the operation, THSR group Harris hip function score is 90.8 points (77 to 98 points), THR group Harris hip function score is 88.9 points (72 to 92 points), 91% of 22 patients do not need to take pain medication, total satisfactory rate was 90.9%. Compared with the postoperative Harris hip function score, the difference of two groups is not statistically significant. But in the complication of two groups, THR group is relatively higher rate than THSR group in the appearance of dislocation of the hip and thigh pain. By reason of young, more activities and higher implant wear, THSR group is prone to aseptic loosen and periprosthetic bone hyperplasia in early stage.Conclusion:The artificial joint replacement surgery is a reliable method in treating the ANFH (ARCOⅢ(B, C) andⅣ). THSR has less blood loss and well hip motive range, it can reduce the incidence of dislocation and complications, which fit for the hip joint with less hip deformity and well local bone conditions, especially the young and active patients; THR is suitable for the elderly patients or the patients who have poor bone conditions (large cystic change in femoral head, necrosis involved the femoral neck, femoral neck trauma history). The metal-on-metal total hip surface replacement surgery has less injury, it can save more femoral bone mass and won the time for the young ANFH patients. THSR can partially replace the conventional position of THR.