In young patients with advanced
necrosis of the femoral head, the short- and medium-term results of total
prosthesis arthroplasty are the most satisfactory. However, the prospect of aseptic loosening hangs over such
arthroplasties like Damocles' sword. Reports from the literature suggest that, in addition to the age of the patient, there is also an endogenous factor that can be responsible not only for the etiology and pathogenesis of the
necrosis, but also for the early loosening of the
prosthesis. We have followed up 54 patients (73 hip joints) who had
total hip replacement as a result of
necrosis of the femoral head between 1976 and 1988. Altogether, 3 acetabular and 5 femoral shafts had to be replaced (7 patients). This corresponds to a loosening rate of 10% after an average of 4.9 years. Hence, the
prosthesis changing rate is lower than that reported by other authors, but is still higher than in patients with
coxarthrosis. Only 2 of 52 cemented shaft
prostheses had to be replaced; the average age of these patients was 61.4 years. Of the 21 cement-free shaft implantations, 3 had to be replaced, the average age of these patients being 42.9 years. The fact that the average age of the latter patients was lower may be the reason for the revision rate not being significantly higher for the non-cemented shafts. In view of the fact that
necrosis of the femoral head can rapidly result in the patient becoming an invalid if it is allowed to follow its natural course, hip joint
prostheses should also be offered to younger patients.