Bipolar Hemiarthroplasty – Does It Make Sense in AVNF?

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Presentation transcript:

Bipolar Hemiarthroplasty – Does It Make Sense in AVNF? Chun-Hsiung Shih, M.D. Superintendent, Taipei Chung Shan General Hospital Visiting Professor, Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital 2018年12月4日

Treatments of AVNF Ficat I, II : Medication (e.g. Fosamax etc.) Shock wave, HBO Core decompression Bone graft (vascularized, non-vascularized) Osteotomy (varus, valgus, rotational) Others Ficat III: Bipolar, THA Ficat IV: THA

Bipolar < THA in AVNF Clinical Result THA : AVNF < O.A. Bipolar < THA in AVNF

Bipolar vs. Total Hip Arthroplasty for Hip Osteonecrosis in the Same Patient Yi-Sheng Chan, M.D. and Chun-Hsiung Shih, M.D* *source: Clinical Orthopaedics 379: 169-177, 2000

Materials and Methods 1986-1994 28 patients (26M/2F); average age: 44.6 (23-58) Bilateral AVNF, one side hip Bipolar (Ficat III) and other side THA (Ficat III or IV) Osteonics type of prosthesis Non-cemented Followup 6.5 years (4-12 years)

Comparison of Clinical Results Parameter Bipolar Side THA Side P-value Satisfactory Rate 85.7% 82% > 0.05 Thigh Pain 7.2% 10.7% Groin Pain

Comparison of Complications Parameter Bipolar Side THA Side P-value Revision of Component Femoral Cpt. Acetabular Cpt. 1 (3.6%) 2 (7.2%) > 0.05 Osteolysis 5 (18%) < 0.05 Dislocation

1993.4.17

Discussion Causes of unfavorable results in the previous reports Cartilage damage of the acetabular side Mismatch of Bipolar head to the acetabulum Soft tissue tension of the hips after operations Individual’s tolerance difference in pain and discomfort

Advantage of Bipolar Endoprosthesis Less dislocation Less PE wear and osteolysis Buy time for further revision Easier revision

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