Osteonecrosis

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Femoral Head Replacement This is basically half a total hip replacement. All comments about femoral head resurfacing apply to femoral head replacement. However, because a femoral head replacement also puts a stem inside the femoral bone (the femoral shaft) it is a little more extensive than the resurfacing procedure. If it needs to be revised, it is a little more difficult to convert to a total hip replacement than the resurfacing procedure.

Total Hip Replacement When the ON is advanced to the point that there is involvement of the socket as well, then the only thing that will be effective is either a hip fusion (making the hip completely stiff) or a total hip replacement. Total hip replacement is one of the most successful surgical procedures ever devised. Success rates are usually above 95%! The problem with total hip replacements for patients with ON is that it is not uncommon for the patient to have a life expectancy of more than 40 or even 50 years. With current technology we don't think that it is likely that at total hip replacement will last that long. For this reason, many physicians will want to try some procedure to put off total hip replacement for a few years even when it is known that that proceudre will not in itself be successful forever. If your disease is advanced, and/or extensive, then THR may be the only thing that makes sense.

Future Directions

Although there are several hundred thousand patients alive in the US with ON, this is largely due to the fact that the average patient will live 30-40 years. With only 15-20,000 new cases each year (this is about the same as the number of practicing orthopedic surgeons in the US).

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