Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2009-06-16

AUTHORS

Bai-Liang Wang, Wei Sun, Zhen-Cai Shi, Nian-Fei Zhang, De-Bo Yue, Wan-Shou Guo, Shao-Hui Shi, Zi-Rong Li

ABSTRACT

Nontraumatic osteonecrosis of the femoral head (non-ONFH) is a disorder that can lead to femoral head collapse and the need for total hip replacement. Various head-preserving procedures have been used for this disease to avert the need for total hip replacement. These include various vascularised and nonvascularised bone grafting procedures. We examined the effect of bone-grafting through a window at the femoral head-neck junction known as the “light bulb” approach for the treatment of osteonecrosis of the femoral head with a combination of demineralised bone matrix (DBM) and auto-iliac bone. The study included 110 patients (138 hips; 41 females, 69 males; mean age 32.36 years, range 17–54 years) with stage IIA–IIIA nontraumatic avascular necrosis of the femoral head according to the system of the ARCO (Association Research Circulation Osseous). The bone grafting procedure is called “light bulb” procedure in which the diseased bone was replaced by a bone graft substitute (combination of DBM and auto-iliac bone).The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The mean follow-up was 25.37 months (range 7–42 months). All data were processed by a statistics analysis including Cox risk model analysis and Kaplan-Meier survival analysis. Pre- and postoperative evaluations showed that the mean Harris hip score increased from 62 to 79. Clinically, 94 of 138 hips (68%) were successful at the latest follow-up, and radiological improvement was noted in 100% of patients in stage IIA, 76.67% of patients in stage IIB and 50.96% of patients in stage IIC and IIIA cases. Excellent and good results according to the Harris score were obtained in 100% of cases in stage IIA, 93.33% in stage IIB and 59.62% in stages IIIA and IIC stage, with a survivorship of 85% in stages IIA and IIB and 60% in stage IIIA and IIC cases. Cox risk model analysis showed that the clinical success rate correlated with both pre-operation stage and the necrotic area of the femoral head. The complications included ectopic ossification, lateral femoral cutaneous nerve lesion and joint infection. This procedure may be effective at avoiding or forestalling the need for total hip replacement in young patients with early to intermediate stages of osteonecrosis of the femoral head. Therefore, it may be the treatment of choice particularly in nontraumatic osteonecrosis of the femoral head of pre-collapse stage with small and middle area (<30%, or the depth of collapse <2 mm). More... »

PAGES

635-639

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00264-009-0822-1

DOI

http://dx.doi.org/10.1007/s00264-009-0822-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1033941711

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19529935


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40 IIIA cases
41 IIIa
42 IIb
43 IIc
44 IIc cases
45 Kaplan-Meier survival analysis
46 analysis
47 approach
48 area
49 auto-iliac bone
50 avascular necrosis
51 better results
52 bone
53 bone graft substitute
54 bone impaction
55 bone matrix
56 bulb
57 cases
58 changes
59 choice
60 clinical success rate
61 collapse
62 combination
63 complications
64 cutaneous nerve lesion
65 data
66 disease
67 diseased bone
68 disorders
69 ectopic ossification
70 effect
71 evaluation
72 femoral cutaneous nerve lesion
73 femoral head
74 femoral head collapse
75 femoral head-neck junction
76 femoral neck window
77 graft substitute
78 head
79 head collapse
80 head-neck junction
81 head-preserving procedures
82 hip
83 hip replacement
84 hip score
85 impaction
86 improvement
87 infection
88 intermediate stage
89 joint infection
90 junction
91 lateral femoral cutaneous nerve lesion
92 lesions
93 light bulbs
94 matrix
95 mean Harris hip score
96 middle area
97 model analysis
98 months
99 neck window
100 necrosis
101 necrotic areas
102 need
103 nerve lesions
104 nontraumatic avascular necrosis
105 nontraumatic osteonecrosis
106 ossification
107 osteonecrosis
108 outcomes
109 patients
110 postoperative evaluation
111 pre-collapse stage
112 pre-operation stage
113 procedure
114 progression
115 radiographic stage
116 radiological improvement
117 rate
118 replacement
119 results
120 risk model analysis
121 scores
122 stage
123 stage IIA
124 stage IIA–IIIA nontraumatic avascular necrosis
125 stage IIB
126 stage IIC
127 stage IIIA
128 statistic analysis
129 study
130 substitute
131 success rate
132 survival analysis
133 survivorship
134 system
135 total hip replacement
136 treatment
137 treatment of choice
138 treatment of osteonecrosis
139 window
140 younger patients
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