应用LCU股骨柄假体行全髋置换术的早期疗效

目的探讨应用LCU股骨柄假体行生物学固定型全髋关节置换术(total hip arthroplasty,THA)的早期疗效。方法回顾性分析2011年8月至2013年4月采用LCU股骨柄假体行THA术85例(90髋),男26例(28髋),女59例(62髋);年龄19~83岁,平均55岁;平均体重指数(23.33±3.13)kg/m2。单髋80例,双髋5例。发育性髋关节发育不良34例(38髋),股骨颈骨折14例(14髋),股骨头坏死17例(17髋),原发性髋关节骨关节炎18例(19髋),类风湿性髋关节炎1例(1髋),髋关节结核1例(1髋)。股骨侧假体均采用LCU股骨柄假体。髋臼采用陶瓷-陶瓷界面者78髋,陶瓷-聚乙烯12髋。对术后及随访时的影像学资料进行分析,末次随访时采用髋关节Harris评分标准评定疗效。结果 82例(87髋)患者术后获得随访,随访12~32个月,平均19个月,3例失访。术前髋关节功能Harris评分为(33.73±3.21)分,末次随访时髋关节功能Harris评分改善至(92.84±4.47)分,与术前比较差异有统计学意义(t=242.69,P0.01)。末次随访时大腿轻度疼痛1例,中度疼痛1例,无重度疼痛。末次随访时无一例出现骨溶解、假体松动,按Engh标准评定:所有获访者均获骨长入固定,其中股骨侧假体诊断为骨性固定者85髋,诊断为纤维性稳定者1髋。假体下沉小于2 mm者1髋,其余均无假体下沉。结论 LCU股骨柄假体行生物学固定型THA的早期疗效满意。     

S-ROM假体初次全髋关节置换治疗合并股骨近端畸形的髋关节晚期病变

目的探讨初次全髋关节置换术中采用组配式S-ROM假体重建股骨近端畸形的近期临床疗效。方法自2010年1月至2015年12月共收治合并股骨近端畸形的晚期髋关节病变患者34例(38髋),按Berry分类,原发病为髋关节发育不良有22例(26髋),其中CroweⅢ型14例(14髋),CroweⅣ型8例(12髋);化脓性髋关节炎后遗畸形4例(4髋);创伤后股骨畸形8例(8髋)。行全髋关节置换术时均采用组配式S-ROM假体重建股骨近端畸形,术后随访并进行临床疗效评估和放射学检查。结果所有患者均获得随访,随访时间18~40个月,平均28个月。术后6个月Harris髋关节评分由术前的(47.3±4.5)分恢复至术后的(86.8±3.9)分,差异有统计学意义(P0.05),患侧肢体平均延长2.58cm,术后未出现坐骨神经损伤、感染、股骨截骨处骨不愈合、假体松动及下沉征象。结论合并股骨近端畸形的髋关节晚期病变患者初次全髋关节置换术中运用组配式S-ROM假体重建股骨近端畸形,可很好的矫正股骨近端畸形、重建髋关节功能,且手术操作安全、并发症少、临床疗效好。     

解剖型股骨假体置换治疗重度髋关节发育不良疗效分析

目的探讨解剖型股骨假体置换治疗重度髋关节发育不良(developmental dysplasia of the hip,DDH)的疗效。方法回顾分析2009年9月-2013年9月,48例(51髋)因重度DDH选择解剖型股骨假体行初次人工全髋关节置换术患者的临床资料。男5例(5髋),女43例(46髋);年龄28~67岁,平均51岁。左髋25例,右髋20例;双髋3例。根据Crowe分型标准:Ⅲ型39例(44髋),Ⅳ型9例(7髋)。患者术前疼痛视觉模拟评分(VAS)为(5.72±1.84)分,Harris评分为(41.66±4.87)分。术前肢体短缩长度(4.31±0.84)cm。结果手术时间59~110 min,平均78.6 min;住院时间6~20 d,平均12.3 d。术后切口均Ⅰ期愈合,2例并发下肢肌间静脉血栓形成。患者均获随访,随访时间10~54个月,平均29个月。9例术后早期伴跛行步态,1年内消失;其余患者步态均正常。末次随访时,VAS评分为(1.46±0.47)分,Harris评分为(88.66±3.48)分,健患侧肢体长度相差(1.15±0.33)cm,与术前比较差异均有统计学意义(P0.05)。X线片复查示,随访期间均无假体松动、下沉、异位骨化、骨质溶解并发症发生。结论采用解剖型股骨假体置换治疗重度DDH,能有效缓解疼痛,改善关节功能,恢复肢体短缩,近期疗效满意。     

数字骨科技术在股骨近端畸形全髋关节置换术中的应用

目的探讨数字骨科技术在股骨近端畸形全髋关节置换术中应用的临床价值。方法回顾性分析自2013-02—2018-01完成的11例全髋关节置换术,患者均合并同侧股骨近端畸形。在计算机辅助设计软件中进行三维建模、解剖数据测量、模拟截骨矫形、选择合适假体、假体安装组配等术前规划,根据术前规划设计与患者解剖结构贴伏的截骨导板及假体安装导向。结果 11例均获得随访,随访时间平均14(4~45)个月。7例需截骨矫形者股骨畸形矫正满意,术中均顺利置入假体。术后3个月髋关节功能Harris评分为(85.36±3.3)分。末次随访时6例双下肢不等长差值<0.5 cm,5例双下肢不等长差值在0.5~1.0 cm之间。结论数字骨科技术应用于股骨近端畸形全髋关节置换术中可获得满意的效果,术前手术规划更为科学,术中股骨近端畸形矫正难度降低、矫形准确性提高,下肢力线重建及假体安装更准确。     

短柄股骨假体全髋关节置换术后股骨近端骨改建及有限元分析

目的通过观察股骨假体周围骨密度改变情况来分析短柄股骨假体全髋关节置换术后股骨近端骨改建情况。方法纳入自2011-06—2016-06完成的71例全髋关节置换术,35例(37髋)采用短柄股骨假体(短柄组),36例(37髋)采用常规股骨假体(常规组)。比较两组术后1年疼痛VAS评分、髋关节功能Harris评分、股骨假体周围骨密度。采用有限元法分析两种股骨假体置入后的应力遮挡情况。结果 71例均获得随访,随访时间13～15(13.2±0.8)个月。短柄组与常规组术后1年疼痛VAS评分、髋关节功能Harris评分差异无统计学意义(P0.05)。与术后1周比较,术后1年短柄组股骨假体周围Gruen 1区和5区骨密度无明显变化,Gruen 4区骨密度降低,而Gruen 2、3、6、7区骨密度增加;常规组术后1年股骨假体周围Gruen 1、2、3、5、6、7区骨密度降低,而Gruen 4区骨密度升高。术后1年短柄组股骨假体周围所有Gruen分区骨密度均高于常规组,差异有统计学意义(P0.05)。有限元分析结果显示常规组股骨近端内侧与外侧均出现应力遮挡,而短柄组仅在股骨近端外侧出现应力遮挡。结论短柄股骨假体具有良好的力学传导特性,全髋关节置换术中使用短柄股骨假体可促进股骨近端骨改建并减少应力遮挡。     

生物型人工全髋关节置换术治疗股骨近段畸形合并终极髋关节疾病

目的探讨生物型人工全髋置换术(total hip arthroplasty,THA)联合截骨矫正术治疗股骨近段畸形合并终极髋关节疾病的临床疗效。方法 2005年2月-2013年6月,采用生物型THA联合截骨矫正术治疗48例(51髋)股骨近段畸形合并终极髋关节疾病患者。男14例(16髋),女34例(35髋);年龄19~83岁,平均52岁。单髋45例,双髋3例。髋关节发育不良36例(39髋),创伤性关节炎3例(3髋),有股骨转子间外翻截骨手术史1例(1髋),股骨近端骨折内固定失败4例(4髋),陈旧性髋关节结核3例(3髋),陈旧性化脓性感染1例(1髋)。Trendelenburg征均呈阳性,19例双下肢不等长。畸形位于股骨大转子4髋,股骨颈39髋,股骨干骺端7髋,股骨干1髋。髋关节功能Harris评分为(34.28±3.28)分。结果术后患者切口均Ⅰ期愈合。1例发生下肢深静脉血栓形成,无感染、神经血管损伤以及脱位等并发症发生。47例(50髋)获随访,随访时间1~9年,平均3.8年。末次随访时,髋关节功能Harris评分改善至(92.87±4.57)分,与术前比较差异有统计学意义(t=—213.19,P=0.00)。6髋Trendelenburg征阳性,其余均为阴性。39例步态恢复正常,8例存在轻度跛行。X线片示畸形完全矫正,截骨区均获骨性愈合,愈合时间3~6个月,平均4.4个月;末次随访时股骨及髋臼假体均获骨长入性固定;股骨假体周围Gruen 1、7区呈局限性骨溶解者2例,髋臼假体周围未发现骨溶解,无假体松动。结论采用生物型THA联合截骨矫正术治疗股骨近段畸形合并终极髋关节疾病,可获得满意疗效。     

生物型加长柄在全髋关节置换股骨侧翻修术中的应用

目的探讨生物型加长柄在全髋关节置换股骨侧翻修术中的临床应用效果。方法回顾性分析自2014-08—2018-12采用生物型加长柄行股骨侧翻修的62例全髋关节置换术,其中股骨假体无菌性溶解松动24例,股骨假体周围骨折18例,股骨假体感染性松动20例。比较手术前后疼痛VAS评分、髋关节功能Harris评分,观察随访期间有无股骨假体周围骨折、髋关节感染、假体松动等并发症发生。结果 62例均顺利完成手术,手术时间155～215(185.5±35.0)min,术中出血量385～725(425.2±50.4)mL,输血量300～800(350.6±50.8)mL,住院时间9～15(12.4±2.4)d。62例均获得随访,随访时间平均18(12～36)个月。随访期间无假体周围骨折、髋关节感染、假体松动发生。末次随访时疼痛VAS评分为(1.82±1.02)分,较术前(7.86±1.05)分明显降低;末次随访时髋关节功能Harris评分为(88.50±6.25)分,较术前(52.80±10.52)分明显提高,差异有统计学意义(P0.05)。结论生物型加长柄在全髋关节置换股骨侧翻修术中应用可取得较好的早中期临床随访结果,而且对于股骨近端轻度缺损患者有一定优势。     

防旋股骨近端髓内钉治疗老年股骨转子间骨折效果观察

目的观察防旋股骨近端髓内钉治疗老年股骨转子间骨折的效果。方法对50例老年股骨转子间骨折应用防旋股骨近端髓内钉治疗,观察骨折愈合时间、髋关节Harris评分及并发症发生情况。结果手术时间(53±5.52)min,术中出血量(140±10.21)m L。术后发生并发症4例,尿路感染2例、切口感染1例,压疮1例。患者均获随访时间6个月~18个月。50例均骨性愈合,愈合时间(4.20±1.02)个月,无未发生髋内翻畸形和断钉,参照Harris髋关节功能评分标准,髋关节功能优良率92.00%(46/50)。结论防旋股骨近端髓内钉治疗老年股骨转子间骨折创伤小,固定稳定,不良反应低,优良率高。     

Wagner SL股骨假体治疗复杂股骨近端骨折的疗效观察

目的探讨Wagner SL股骨假体治疗复杂股骨近端骨折的疗效。方法自2009-01—2015-05采用Wagner SL股骨假体治疗60例复杂股骨近端骨折,记录手术时间及出血量,采用髋关节功能Harris评分进行评价。结果手术时间45~200(95±27)min,术中出血400~1 500(600±240)ml,术后输血2~10 U悬浮红细胞。所有患者切口均一期愈合,术后假体位置佳。共50例获得随访2~68(34±19)个月,术前Harris评分35~75(58±10)分,末次随访Harris评分65~93(81±9)分,假体无明显松动,假体周围无透亮带、下沉。结论采用Wagner SL股骨假体治疗复杂股骨近端骨折疗效满意,值得临床推广。     

股骨大转子延长截骨在假体稳定股骨柄翻修中的应用

目的 评估大转子延长截骨在股骨假体固定稳定型全髋关节翻修术中应用的中期临床效果.方法 1998年1月至2005年6月对27例患者(27髋)采用大转子延长截骨对股骨柄和(或)骨水泥壳固定稳定的全髋关节翻修.临床随访评估包括Harris评分和WOMAC评分,术前Harris评分平均42.7分,WOMAC评分平均55.6分;影像学评估包括术后拍摄X线片,对比观察截骨块愈合时间、是否存在截骨延迟愈合或不愈合,截骨块是否发生移位以及假体是否下沉等.结果 共19例患者(19髋)获得随访,平均随访时间5.3年.无一例发生术中或术后骨折.术后Harris评分平均87.3分,WOMAC评分平均46.3分.所有患者大转子截骨块均于术后6个月内愈合.无股骨大转子截骨块向近端移位,3例发生股骨柄下沉,平均下沉3.4 mm,无钢丝断裂.结论 对于假体固定稳定型股骨柄翻修,采用股骨大转子延长截骨有利于手术操作和翻修假体的植入和固定,有利于截骨块的愈合,降低术中、术后并发症发生率,中期疗效显著.     

Cementless femoral reconstruction in patients with proximal femoral deformity

Distorted proximal femoral anatomy can pose a great technical challenge during total hip arthroplasty. Fifty-eight total hip arthroplasty were performed in 51 patients with proximal femoral deformity from 1998 to 2006. All hips except 2 were treated with cementless prosthesis. Twenty-three patients had a retained hardware that had to be removed. Nonprimary cementless components were used in 22 (25%) femurs. In 21 (23%) hips, osteotomy was required to properly fit the cementless stem in the femur. At the time of latest follow-up (4 years on average), functional scores showed significant improvement. Radiographically, all femoral components showed stable bone ingrowth except 2 hips (3.5%) with stable fibrous ingrowth and 1 hip (2%) with loosening. There were 2 (3.5%) revisions in 2 patients for periprosthetic fracture and femoral loosening. The mechanical failure rate was 9% (5 hips). Despite technical difficulties, cementless femoral reconstruction provides a reliable and durable result in patients with proximal femoral deformity.     

Periacetabular osteotomy for the treatment of acetabular dysplasia associated with major aspherical femoral head deformities

BACKGROUND: Acetabular dysplasia associated with deformity of the proximal part of the femur can result in hip dysfunction and degenerative arthritis in young adults. The optimal method of surgical correction for these challenging combined deformities remains controversial. METHODS: We retrospectively analyzed twenty-four hips in twenty patients who underwent a Bernese periacetabular osteotomy, which was done with a proximal femoral valgus-producing osteotomy in thirteen hips, for the treatment of acetabular dysplasia associated with proximal femoral structural abnormalities. The average age of the patients at the time of surgery was 22.7 years, and the average duration of clinical follow-up was 4.5 years. The Harris hip score and overall patient satisfaction with surgery were used to assess hip function and clinical results. Plain radiographs were used to assess the correction of the deformity, healing of the osteotomy, and progression of degenerative arthritis. RESULTS: The mean Harris hip score increased from 68.8 points preoperatively to 91.3 points at the time of the most recent follow-up (p<0.0001). Sixteen patients (nineteen hips) had an excellent clinical result, and one patient (one hip) had a good result. Two patients (two hips) had a fair result, and one patient (two hips) had a poor result. Twenty-two of the twenty-four hips improved clinically. There was an average improvement of 27.6 degrees in the lateral center-edge angle of Wiberg (p<0.0001), an average improvement of 33.1 degrees in the anterior center-edge angle of Lequesne and de Seze (p<0.0001), and an average improvement of 16.5 degrees in the acetabular roof obliquity (p<0.0001). The hip center was translated medially an average of 6.3 mm (p=0.0003). The T?nnis osteoarthritis grade was unchanged in twenty hips, progressed one grade in three hips, and progressed two grades in one hip. There were three major technical complications. At the time of the most recent follow-up, none of the hips had required total hip arthroplasty. CONCLUSIONS: The combination of acetabular dysplasia and proximal femoral deformities presents a complex reconstructive problem. The range of motion and radiographic assessment of the hip are major factors in the selection of patients for surgery. In selected patients, the periacetabular osteotomy combined with concurrent femoral procedures, when indicated, can provide comprehensive deformity correction and improved hip function.     

Proximal femoral osteotomy for the treatment of hip arthritis in young adults

Background : The outcome of proximal femoral osteotomy for hip arthritis in young adults performed at the Wellington Hospital (Wellington, New Zealand) was reviewed. Methods : Seventeen patients underwent 21 proximal femoral osteotomies for the treatment of hip arthritis at Wellington Hospital between 1992 and 1999. Thirteen patients (17 hips) were contacted and were able to complete a questionnaire form specific for hip pain and function. Results : There was a response rate of 76.5% (13 out of a possible 17 patients undergoing proximal femoral osteotomy) at a mean 3 years 4 months postoperatively. Of these, one patient has had a total hip joint replacement and one patient is currently on the waiting list for a total hip joint replacement. Three other patients (three hips) report moderate or severe hip pain. The remaining eight patients (12 hips) report having mild or no hip pain. Questionnaire results show a postoperative decrease in hip pain in most patients. Hip function as assessed by the questionnaire was essentially unchanged. Conclusions : Proximal femoral osteotomy is a satisfactory option for young patients with degenerative hip arthritis. The operation is only likely to be useful in the treatment of pain.     

Total joint arthroplasty in orthotopic liver transplant recipients

Eight total hip and two total knee arthroplasties were performed from 1986 to 1991 in eight patients who had orthotopic liver transplantation. The indications for joint arthroplasty were avascular necrosis of the femoral head in five hips, pathologic femoral neck fracture caused by osteopenia in three hips, avascular necrosis of femoral and tibial condyles in one knee, and posttraumatic arthritis in one knee. Six patients (75%) had significant osteopenia. The mean interval between liver transplantation surgery and hip or knee joint arthroplasty was 2 years (8–48 months). The patients who had hip arthroplasty were followed for a mean of 4.85 years (2–8 years), and those who had a knee arthroplasty after a hip arthroplasty, for a mean of 3.5 years (2–5 years) after the knee arthroplasty. In the patients who had hip arthroplasty, the mean Harris hip score was improved from 34 to 82 points. In the two patients who had a knee arthroplasty, the mean score was improved to 100 points both for pain and function of the knee and for overall function from mean preoperative knee scores of 49 and 25 points, respectively. Radiographs did not reveal any loosening of the components. None of the patients required reoperation, and there were no serious postoperative complications.     

Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem

The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.     

Cementless total hip arthroplasty using the modular S-ROM prosthesis combined with corrective proximal femoral osteotomy

We present the results of total hip arthroplasty using S-ROM (Depuy, Warsaw, Ind) prosthesis combined with corrective femoral transverse osteotomy for hips with proximal femoral deformity. Fourteen hips were followed up for a mean of 61 months (range, 36-95 months), with a mean age at surgery of 55 years (range, 44-69 years). The average intraoperative blood loss was 638 mL, and the average operative time was 136 minutes. The average Harris Hip Score increased from 38.0 (range, 15.0-55.7) preoperatively to 82.0 (range, 34.6-92.7) at the latest follow-up. All the hips except for 1 acquired union of osteotomy and bone ingrowth. S-ROM modular stem, which gives sufficient rotational stability at both proximal and distal parts of the osteotomy, is useful for total hip arthroplasty combined with corrective femoral transverse osteotomy.     

全髋表面置换术治疗股骨头坏死短期随访研究

目的：研究全髋表面置换术治疗股骨头坏死的短期疗效,探讨表面置换术治疗股骨头坏死技术要求和手术指征。方法：对2006年12月至2009年12月37例（43髋）行全髋表面置换术的股骨头缺血坏死患者进行随访,男25例,女12例;年龄21～67岁,平均44.5岁。按照ARCO进行分期：3A期3髋,3B期6髋,3C期16髋,4期18髋。根据Harris评分系统对手术前后关节疼痛、活动度、畸形矫正及功能的改善进行对比,用Charnley法比较术后假体松动X线改变。结果：失访3例,34例（40髋）获得随访,37髋疼痛完全缓解,3髋行走后有酸痛不适。随访时间16～53个月,平均32.4个月。术前Harris平均评分（51.5±1.7）分,术后32.4个月平均（94.3±1.4）分,较术前提高。优37髋,良3髋,差0髋。34例都恢复了正常生活或工作,术后疼痛明显缓解,其中3例（髋）长距离行走后有轻度酸痛不适,休息后缓解。1例异位骨化BrookerⅢ型,无疼痛,不影响正常行走和生活。无术后股骨颈骨折,无脱位,无松动和翻修。结论：经过适当患者选择、术中的精细操作,全髋表面置换术治疗股骨头缺血坏死可以获得满意的短期疗效。     

Clinical features and treatment of the hip in multiple epiphyseal dysplasia in childhood

Multiple epiphyseal dysplasia is a rare congenital osteochondrodysplasia disorder characterized by a delay in the appearance of the epiphyses; irregular, symmetric epiphyseal formation; mild short stature; and early-onset osteoarthritis. Peripheral weight-bearing and nonweight-bearing joints can be affected. Treatment of the hip deformity in multiple epiphyseal dysplasia is a challenge for orthopedic surgeons.We reviewed the clinical features and treatment options of hip joints affected by multiple epiphyseal dysplasia in 6 young patients (4 boys and 2 girls). Average patient age was 8.8 years (range, 5-14 years). The spectrum of hip joint deformity ranged from mild to severe. Surgical procedures included intertrochanteric extension osteotomy of the femur in 2 patients (4 hips), Staheli acetabular augmentation in 1 patient (2 hips), and trochanter arthroplasty associated with Dega osteotomy in 2 patients (4 hips). One patient did not undergo surgical treatment. All patients were followed up for an average 7.2 years. Joint function improved in the patients treated surgically. The coxa vara deformity was corrected satisfactorily, and the femoral head was covered completely by the acetabulum.Good mid-term outcomes were obtained for the treatment of severe hip deformity by using intertrochanteric extension osteotomy and trochanter arthroplasty. However, because of the inherent nature of this disorder, long-term follow-up of the patients is required.     

Hip and Knee Arthroplasty in Hypophosphatemic Rickets

There is very limited published information about the technical aspects and durability of lower extremity arthroplasty in hypophosphatemic rickets. Between 1972 and 2006, 8 total hip arthroplasties (THAs) and 6 total knee arthroplasties (TKAs) were performed in 8 patients with degenerative arthritis and bone deformity secondary to hypophosphatemic rickets. Two hips required osteotomies at the time of arthroplasty, and 1 TKA patient required postoperative osteotomies. Specialized implants were required in 3 hips and 1 knee. At average follow-up of 7 years, mean Harris hip scores improved to 21 points, and mean Knee Society pain and function scores improved to 48 points and 27 points, respectively. One cemented THA failed due to femoral aseptic loosening at 13 years postoperatively; all other implants remained well fixed. Lower extremity arthroplasty is effective and durable for patients with arthritis associated with hypophosphatemic rickets, but corrective osteotomies and use of special implants should be anticipated with more severe deformities.     

Histologic analysis of acetabular and proximal femoral bone in patients with osteonecrosis of the femoral head

BACKGROUND: The purpose of this study was to investigate the hypothesis that osteonecrosis of the femoral head may also involve the acetabulum and the proximal part of the femur. METHODS: Twenty-five patients who underwent simultaneous bilateral total hip arthroplasty and thirty-eight patients who had a unilateral total hip arthroplasty for treatment of symptomatic osteonecrosis of the femoral head were included in the study. There were fifty-five men and eight women. The etiology of the osteonecrosis was idiopathic in forty patients (fifty-six hips, 64%), associated with ethanol abuse in eighteen patients (twenty-five hips, 28%), and associated with steroid use in five patients (seven hips, 8%). The mean age of the patients at the time of arthroplasty was 47.1 years. We performed cancellous bone biopsies in the acetabulum, the proximal part of the femur, and the femoral head intraoperatively and then examined the specimens histologically. RESULTS: Of the eighty-one hips with idiopathic or ethanol-associated osteonecrosis, seventy-six (94%) had normal or stage-1 bone in the acetabulum and the proximal part of the femur according to the system of Arlet and Ficat, and seventy-eight (97%) of the eighty-one had a grade of 0 or 1 according to the system of Humphreys et al. Of the seven hips with steroid-associated osteonecrosis, four had normal or stage-1 bone and a grade of 0 or 1 and three had stage-2 or 3 disease and a grade of 2 or 3. Therefore, the vast majority of hips with idiopathic or ethanol-associated osteonecrosis had normal or nearly normal bone in the acetabulum and the proximal part of the femur. Three of the seven hips with steroid-associated osteonecrosis had abnormal bone in the proximal part of the femur only. CONCLUSIONS: One can expect to find normal or nearly normal cancellous bone in the acetabulum and the proximal part of the femur of patients with either idiopathic or ethanol-associated osteonecrosis of the hip. More extensive osteonecrosis may accompany steroid-associated osteonecrosis of the hip.