Quality of life following femoral osteotomy and total hip arthroplasty for nontraumatic osteonecrosis of the femoral head.

BACKGROUND: Nontraumatic osteonecrosis of the femoral head (NOFH) frequently develops in active young persons. The affected femoral head collapses owing to weight-bearing, and the individual's quality of life (QOL) can be predicted to deteriorate greatly with time. We undertook to determine the efficacy of surgery and to clarify whether patient QOL differs according to differences in the surgical method employed.

METHODS: We cross-sectionally compared QOL in NOFH patients treated with femoral osteotomy, total hip arthroplasty (THA), or nonoperatively. A total of 81 cases were available for study, comprising 41 with osteotomy, 19 with THA, and 21 in the nonoperative group. The mean age was significantly higher in the THA group than in the other two groups. The Japanese Orthopaedic Association (JOA) hip score and Visual Analogue Scale (VAS) regarding hip pain were compared among the groups. These groups were also analyzed for their health-related QOL using the Short Form Health Survey (SF-36) with analysis of variance for age adjustment.

RESULTS: The mean JOA score was significantly lower in the nonoperative group than in the osteotomy group. The mean VAS scores showed no significant difference between any of the three groups. Regarding the subscales of SF-36, the physical functioning subscale in the nonoperative group showed a significantly lower value than was seen in the osteotomy group (P = 0.003). The physical component summary (PCS) scores were 39.4 (osteotomy group), 39.1 (THA group), and 27.8 (nonoperative group), with a significant difference between the osteotomy and nonoperative groups (P = 0.027). There was also a trend for a better PCS scores in the THA group than in the nonoperative group (P = 0.056). The mental component summary scores were 49.6 (osteotomy group), 50.3 (THA group), and 48.3 (nonoperative group), with no significant difference found among any of the three groups.

CONCLUSIONS: Among patients with NOFH, physical function impairment was a more potent factor than pain for decreasing QOL in the nonoperative group than in the surgical groups. Furthermore, osteotomy and THA were similar in regard to the evaluation of the postoperative QOL score if the indications for osteotomy were strictly applied.