Abstract
Objective: To assess the curative effect of the stage II femoral head necrosis treated by arthroscopy assisted lesion clearance, bone graft and titanium rod support. Methods: All the patients (including 58 patients 74 hips) were diagnosed as stage II femoral head necrosis according to the ARCO staging system during 2003-2013. In these patients, 15 hips were stage IIA, 34 hips were stage IIB and 25 hips were stage IIC. Located by C-arm and assisted by arthroscopy, minimally-invasive percutaneous pulp core decompression and lesion clearance within the femoral head were accurately performed, and then, the OAM composite of autologous bone marrow was implanted and the femoral head was supported using the titanium rod. Follow-up including the pain score, the Harris hip score and X-ray observation for disease progression were achieved at 6, 12, 24 and 36 months postoperatively, Kaplan-Meier survival curve was used for the survival analysis. Result: The VAS score and the Harris score after operation were better THRAn THRAt of before the surgery, the difference had statistical significance (p < 0.05). As for the X-ray staging, 5 cases (5 hips) progressed from stage IIB to stage IIC, the femoral head of 6 cases (6 hips) staged IIC collapsed at 24 months after the operation and then underwent THRA after 30 months. In this study, the total improvement rate after the surgery was 79.72% (93.33% for IIA, 82.35% for IIB and 68% for IIC). The total survival rate of these patients was 64.2% (95% CI, 64.2% - 90.1%). Conclusion: Arthroscopy assisted lesion clearance, bone graft and titanium rod support to treat the stage II osteonecrosis of the femoral head are effective and can prevent the femoral head from collapsing. But for stage IIC patients who had a history of the use of hormone, this surgery should be chosen carefully because the outcome is always very poor.
Highlights
As the incidence of osteonecrosis of the femoral head (ONFH) is increasing and the age of onset become younger, [1] [2] [3] [4], how to retain the femoral head and to prevent it from collapsing, avoiding the total hip replacement arthroplasty (THRA) too early, are developing into the trend of early treatment of ONFH [5] [6] [7]
Arthroscopy assisted percutaneous spinal core decompression and the implantation of osteoinductive absorbing material (OAM) which compounded with autologous red bone marrow (ARBM) associated with titanium rod support to treat the state II ONFH were widely accepted by the academic circle
All the stage II ONFH patients caused by hormone, alcohol, trauma, and idiopathic diseases according to the Association Research Circulation Osseous (ARCO) classification [8]
Summary
As the incidence of osteonecrosis of the femoral head (ONFH) is increasing and the age of onset become younger, [1] [2] [3] [4], how to retain the femoral head and to prevent it from collapsing, avoiding the total hip replacement arthroplasty (THRA) too early, are developing into the trend of early treatment of ONFH [5] [6] [7]. Arthroscopy assisted percutaneous spinal core decompression and the implantation of osteoinductive absorbing material (OAM) which compounded with autologous red bone marrow (ARBM) associated with titanium rod support to treat the state II ONFH were widely accepted by the academic circle. Its early curative effect after the surgery is recognized, but the survival rate analysis of the femoral head after the surgery has not been reported statistically by any document. We used this method to treat early stage ONFH and achieved the complete follow-up data during the period of 2003.04 to 2013.12, making a survival analysis.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
