One-stage hip arthroplasty and contralateral core decompression with bone grafting were performed for 30 patients with bilateral
femoral head osteonecrosis between April 2002 and June 2005. The treatment course, clinical and radiographic outcomes, and
medical costs were compared with another 30 age-, gender-, etiology-, and disease extent-matched patients undergoing two-stage
treatment during the same period. The two groups had similar clinical data and few complications. Total hospital stay and
associated costs were reduced for patients who had one-stage treatment. These patients also returned to work faster (6.0 versus
10.8 months). At an average followup of 46 months, progression to greater than 2 mm of collapse of the salvaged femoral head
was observed in seven patients (23%) who had one-stage treatment and 14 patients (47%) who had two-stage treatment. Conversion
to hip arthroplasty was performed in five patients (17%) in the one-stage group and 12 patients (40%) in the two-stage group.
A special group of patients with bilateral osteonecrosis of the femoral head seemed to benefit from one-stage hip arthroplasty
and contralateral core decompression with bone grafting and had better survival of the salvaged femoral head. One-stage hip
arthroplasty and core decompression with bone grafting proved to be a cost-effective method that did not increase perioperative
morbidity.
Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations
were conducted in conformity with ethical principles of research.