Outcomes of Primary Cementless Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis from Osteonecrosis of the Femoral Head: A Matched Cohort Study.

Abstract

Purpose: Total hip arthroplasty (THA) is the only definitive treatment for rapidly destructive coxarthrosis (RDC). THA for RDC has significantly higher perioperative blood loss with a greater requirement for transfusion than non-RDC primary THAs. Given the rarity of the disease, this study aimed to investigate perioperative and long-term outcomes of cementless THA for RDC that developed from osteonecrosis of the femoral head (ONFH).

Materials and methods: Each of 26 RDC patients was matched to a patient with typical advanced-stage ONFH for comparison, according to age, sex, American Society of Anesthesiologists classification, and the type of implant used. As a primary outcome, perioperative blood loss was calculated as the sum of compensated and uncompensated blood loss.

Results: The RDC group had a significantly larger amount of total perioperative blood loss in comparison to the group with typical ONFH (791.5 mL vs. 511.2 mL, P=0.034), which was primarily attributable to compensated blood loss (496.1 mL vs. 141.5 mL, P=0.024), as uncompensated blood loss was not significantly different (P=0.152). Intraoperative transfusion volume was significantly higher in the RDC group (234.6 mL vs. 46.2 mL, P=0.007), while the difference in postoperative transfusion was marginally significant (P=0.092).

Conclusion: THA for RDC was accompanied by a higher perioperative blood loss, attributable mainly to a significant difference in the amount of intraoperative transfusion, in a matched comparison with patients with typical advanced-stage ONFH. However, extended operation time and prolonged hospitalization along with a large volume of transfusion did not translate into inferior long-term outcomes.