Total Hip Arthroplasty After Failed Operative Treatment for Osteonecrosis of the Femoral Head

Of the numerous total hip arthroplasties performed each year for end-stage osteoarthritis a significant number are done in patients who suffer from osteonecrosis of the femoral head. Many of those patients have had a previous surgical treatment in an attempt to preserve the joint and to delay the need for a total hip arthroplasty. These treatments include core decompression with or without bone grafting, proximal femoral osteotomies, and free vascularized bone grafting. Each of these procedures, however, changes the anatomy of the proximal femur and present unique challenges to the orthopedic surgeon attempting to perform a subsequent total hip arthroplasty. Here we discuss the specific pitfalls in performing a total hip arthroplasty after a joint-sparing/preserving procedure and specific strategies with which to deal with each of them.