Clinical and functional outcome of total hip replacement/arthroplasty for avascular necrosis of the femoral head

Abstract

Background: Avascular necrosis (AVN) of the femoral head is a progressive condition leading to femoral head collapse, particularly affecting young to middle-aged adults. Total hip replacement (THR) is the gold-standard salvage procedure for end-stage disease. Methods: This prospective observational study was conducted at Khwaja Yunus Ali Medical College and Hospital, Bangladesh, from January 2024 to January 2026. Forty-five patients with ARCO stage III or IV AVN underwent THR via the Hardinge lateral approach. Outcomes were assessed using the Harris hip score (HHS) preoperatively and at 6, 12, and 24 weeks postoperatively. Complications were recorded throughout follow-up. Results: The mean age was 42.8±10.7 years, with male predominance (73.3%). Corticosteroid use (35.6%) was the most common cause, followed by alcohol abuse (22.2%). Most patients (62.2%) had ARCO stage IV disease. The mean HHS improved from 45.2±8.7 preoperatively to 92.6±4.8 at 24 weeks (p<0.001). Excellent-to-good outcomes were in 84.4%. Complications included limb length discrepancy (6.7%), superficial wound infection (4.4%), Trendelenburg gait (4.4%), and dislocation (2.2%). No deep infections, nerve injuries, or fractures. Conclusions: Total hip replacement via the Hardinge lateral approach offers excellent pain relief, notable functional gains, and low complication rates in advanced AVN of the femoral head. Longer-term studies are needed to evaluate implant survivorship.