© 2015 Wichg Publishing HIP ISSN 1120-7000 Hip Int 2015; 00 (00): 000-000 ORIGINAL ARTICLE increased revision rates have been reported for THA in ONFH, yet newer studies have demonstrated low revision rates for uncemented THA in ONFH comparable to THA for osteoar- thris (OA) (16-19). A recent meta-analysis of 3,277 THAs in 2,593 ONFH paents demonstrated a significantly lower revi- sion rate of 3% in paents who had surgery in 1990 or later as compared to a 17% revision rate in paents with THA before 1990 (17). Despite promising recent results, the literature re- mains conflicted as large European database studies recently demonstrated higher revision THA rates in ONFH paents compared to OA paents (20, 21). Although a large volume of literature exists reporng increased revision rates in THA for ONFH, a comprehensive comparison of all major postopera- ve surgical and medical complicaons in the United States remains lacking. The aim of the present study is to systema- cally compare all surgical and medical postoperave compli- caons including but not limited to prosthec hip dislocaon, wound issues, postoperave infecon, deep vein thrombosis (DVT), pulmonary embolism (PE), and medical complicaons (cardiac, gastrointesnal (GI), respiratory, renal, urinary tract infecon (UTI)) for paents who have had THA for ONFH and THA for OA from a large United States database. Materials and Methods All data was derived from the PearlDiver Paent Re- cord Database (www.pearldiverinc.com; PearlDiver Inc, Fort Wayne, Indiana) of paent records from years 2007-2011. The database was queried for Internaonal Classificaon of Diseases, ninth revision (ICD-9) codes for hip OA (715.15), DOI: 10.5301/hipint.5000224 Does osteonecrosis of the femoral head increase surgical and medical complicaon rates aſter total hip arthroplasty? A comprehensive analysis in the United States Sco Yang, Alexander Y. Halim, Brian C. Werner, F. Winston Gwathmey, Quanjun Cui University of Virginia Health System, Charloesville, Virginia - USA Introducon Osteonecrosis of the femoral head (ONFH) is a disabling condion that oſten leads to collapse of the femoral head aſter an interrupon of blood supply, with subsequent de- generave arthris of the hip. A variety of eologies have been proposed including local factors affecng blood supply such as microvascular damage, increased intraosseous pres- sure, adipogenic differenaon of marrow stem cells and mechanical stresses (1-3). ONFH is oſten observed in paents with excessive alcohol use, coagulopathies, lupus, and other chronic diseases that require long term corcosteroid use (4- 6). Treatment varies according to the disease stage, and in the presence of collapse of the femoral head the most reliable treatment remains total hip arthroplasty (THA) (7). Earlier studies in the ONFH populaon demonstrated high failure rates defined as prosthec loosening or revision in paents who underwent THA for ONFH (8-15). Historically, ABStrACt Total hip arthroplasty (THA) is a definive opon for end-stage osteonecrosis of the femoral head (ONFH). Historically, higher revision rates were observed in this populaon compared to THA for osteoarthris (OA). This study provides a comprehensive evaluaon of postoperave medical and surgical complicaons comparing THA in ONFH and OA at 90 days, 1 year, and 2 years aſter surgery. The PearlDiver database idenfied 45,002 OA and 8,429 ONFH paents who underwent THA. Mechanical complicaons (prosthec loosening and osteolysis, implant failure), dislocaon, renal and respiratory complicaons were significantly increased in the ONFH group within 2 years aſter THA. Pulmonary embolism rates where increased in younger ONFH paents within 2 years aſter THA. This data helps clinicians in the postoperave risk assessment of paents with ONFH. Keywords: Total hip arthroplasty, Osteonecrosis, Complicaons, Avascular necrosis Accepted: December 17, 2014 Published online: Corresponding Author: Sco Yang Department of Orthopaedic Surgery University of Virginia Health System 400 Ray C Hunt Dr, Suite 330 Charloesville 22903 Virginia, USA scoyang84@gmail.com