A comparative study of treatment for necrosis of the femoral head by vascularized iliac bone flap combined with or without tantalum screw

Abstract

Objective To report the short-mid term chnical outcome of vascularized iliac Bone Flap combined with or without tantalum screw for the treatment of necrosis of the femoral head(ONFH). Methods Thirty six ONFH patients (36 hips) were divided into two groups including one hip of stage Ⅱ a, 9 hips of stage Ⅱ b, 6 hips of stage Ⅱ c, 7 hips of stage Ⅲ a, 5 hips of stage Ⅲ b, and 8 hips of stage Ⅲ c according ARCO staging system. 20 hips were in vascularized iliac bone flap transplantation group and 16 hips in vascularized iliac bone flap transplantation combined with tantalum screw group. Preoperative evaluation showed that there was no statistical difference between two groups in Harris score, age and body mass index. Results All patients were followed up 7 to 20 months (average 15 months), there was no statistical difference between two groups in intraoperative blood loss, 24h postoperative VAS score and Harris score of 3 months post-operation. The Harris score of both groups was obviously increased 6 months postoperatively. The average Harris score of vascularized iliac bone flap transplantation combined with tantalum screw group were 82.94 with a 81.25% clinical success rate, compared with the Harris score of group treated without tantalum screw (average, 70.0)with a 65.0% clinical success rate showed statistical difference. Conclusion Vascularized iliac bone flap transplantation combined with tantalum screw was an effective method with high clinical success rate for treatment of younger patients with early-mid stage ONFH. It provided good blood supply and enough mechanical support as to reduce the progress of femoral head collapse. Key words: Necrosis of the femoral head; Tantalum; Bone flap; Microsurgical operation