Abstract
BackgroundTo compare the mid-long-term clinical and radiological outcomes between a combination of cortico-cancellous iliac bone graft with vascularized greater trochanter flap (Group A) and isolate iliac bone graft (Group B) in the treatment of Osteonecrosis of the Femoral Head (ONFH).MethodsFrom January 2006 to December 2012, 123 patients (135 hips) who underwent abovementioned hip-preserving surgeries were included for analysis. Clinical outcomes were assessed based on Harris Hip Score (HHS) System and The Western Ontario and McMaster University Index (WOMAC) scores between the preoperative and the last follow-up. A series of postoperative X-rays were compared to preoperative images for radiological evaluation.ResultsThe HHS in Group A and B were enhanced from 50.57 ± 3.39 to 87.60 ± 4.15 and from 50.24 ± 3.30 to 85.18 ± 6.45, respectively, which both showed significance between preoperative and postoperative latest follow-up (p < 0.001). Group A revealed better improvement in terms of HHS (p = 0.017). The WOMAC total, postoperative stiffness, difficulty subscale scores in Group A showed better outcomes when compared to Group B (p < 0.01), while pain improvement between these two groups revealed no significance (p = 0.402). Besides, Group A suggested better necrotic region repair (p = 0.020), but no femoral head collapse difference in terms of Association Research Circulation Osseous classification change was found (p > 0.05).ConclusionsA combination of cortico-cancellous iliac bone graft and concurrent vascularized greater trochanter flap with the lateral femoral circumflex transverse branch has been proved can obtain better functional and radiological results than isolate iliac bone grafting, which is attributed to blood reconstruction of the femoral head.
Highlights
To compare the mid-long-term clinical and radiological outcomes between a combination of corticocancellous iliac bone graft with vascularized greater trochanter flap (Group A) and isolate iliac bone graft (Group B) in the treatment of Osteonecrosis of the Femoral Head (ONFH)
Osteonecrosis of the femoral head (ONFH) is a common debilitating and disabling condition, which is characterized as blood supply impairment of the femoral head, bone marrow and osteocytes death, subchondral bone collapse, articular cartilage degeneration and ultimate secondary osteoarthritis [1, 2]
Candidates who underwent a combination of iliac bone and vascularized greater trochanter flap with lateral femoral circumflex artery transverse branch and isolate cortico-cancellous iliac bone graft and were divided into Group A and Group B, respectively
Summary
To compare the mid-long-term clinical and radiological outcomes between a combination of corticocancellous iliac bone graft with vascularized greater trochanter flap (Group A) and isolate iliac bone graft (Group B) in the treatment of Osteonecrosis of the Femoral Head (ONFH). Various surgeries have been proposed to improve necrosis bone repair and prevent or postpone progressive collapse, such as core decompression [21], proximal femur rotational osteotomy [22], vascularized [23] or non-vascularized [24] bone grafting, artificial biomaterials impaction [25], bone grafting combining with bone morphogenetic protein [26], and autologous bone marrow aspirate transplantation [27] For these precollapse ONFH cases, bone grafting can provide mechanical support, and improve necrotic region biological environment when necrotic tissues were thoroughly removed [28]. Once blood supply is restored or reconstructed, vital bone can gradually creeping substitute the necrotic tissues and a relative normal subchondral plate is regained
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