Discussion
Although osteonecrosis of the femoral head had been discussed, ONA remained out of attention. There are few reports of ONA in the literature, and had not been discussed as well. This phenomenon may lead to the aseptic loosening of the acetabular component; however the primary involvement had been reported.
Painful hip arthroplasty is well discussed, and many causes have been nominated 8. Infection, loosening, instability, impingement, synovitis, bursitis, tendonitis, heterotopic ossification, stress fracture, and distant causes other than peri-articular such as vascular claudication, are the causes mentioned 8. However, the ONA is not mentioned. Nuclear imaging is helpful in diagnosing PJI and loosening, but it can be positive in the acetabulum even in asymptomatic patients up to two years 8. Sclerosis on plain radiographs, and high uptake on bone scan can be suggestive of osteonecrosis 9. The intraoperative finding (avascularity of acetabulum) confirmed the diagnosis. To our knowledge, this is the first report of ONA after THA.
One of the important predictors of ONA is irradiation10–14. Rheumatoid arthritis and corticosteroids are the other risk factors 6,15–17. Eray et al.18 reported a case of renal implantation who received corticosteroid and immunosuppressive treatment that showed right acetabulum osteonecrosis. Fink et al. 19 reported four cases of ONA, and concluded that, this may be an accompaniment to ONFH. Albright et al. 20 reported two cases of ONA not associated with radiotherapy. One of them had no risk factor, and another was an alcoholic with excessive doses of prednisolone usage. Chou et al. 15 reported a case of ONA with a history of acute lymphoblastic leukemia and corticosteroid use. They used an impaction bone graft as well as total hip arthroplasty for the management of this patient.
As many risk factors are discussed, but there are two reports of ONA following hip arthroplasty. Kobayashi et al. 21reported an aseptic osteonecrosis of the acetabulum following the Austin-Moore hip prosthesis replacement. Merschin and Lenz22 reported a case of the acetabular necrosis after hemiarthroplasty.
Here, in our study, we report on a case of osteonecrosis of the acetabulum following THA. The ONA can be classified as a cause of painful THA, and aseptic loosening of acetabular component. In this case we revised acetabular component with a cemented cup, due to inappropriate bone ingrowth.
Acknowledgment: none
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