Abstract
Objective To assess the effectiveness of various therapeutic hip preservation strategies on patients with nontraumatic osteonecrosis of the femoral head (ONFH). Design This is a systematic review of previous literature and in-depth Bayesian network meta-analysis of randomized controlled trials (RCTs) to compare the clinical effect of various operation methods and one physical intervention (extracorporeal shockwave). Data Sources Electronic literature, for studies published up to December 2017, was collected from PubMed, Medline, and the Cochrane Library. Study Selection We selected RCTs on patients with ONFH. Treatment methods included extracorporeal shockwave (ESW), core decompression (CD), multiple drilling decompression (DD), vascularized fibular grafting (VFG), free-vascularized fibular grafting (FVFG), inverted femoral head grafting (IFHG), vascular iliac pedicle bone grafting (VIPBG), osteotomy, and tantalum implantation (TI). Outcome The primary outcome was Harris score; the secondary outcome was Harris hip score (HHS), including total hip arthroplasty requirement (THA) and progression to collapse. Results A total of 14 randomized controlled trials were investigated. ESW had the highest improvement on Harris score (probability best 52%), followed by VFG (probability was 38%). In the meanwhile, VFG also proved to be superior in reducing the failure rates of treatment (probability lowest 59%), followed by ESW (probability lowest 24%). In femoral necrosis stage-II, VFG achieved the highest probability in preventing treatment failures (52%) and showed better performance in reducing treatment failure rates than CD. Conclusion ESW therapy (ESWT) is the most effective intervention to improve HHS, and VFG shows superior effect on reducing treatment failure rates.
Highlights
Osteonecrosis of the femoral head (ONFH) is a debilitating disorder with a considerably high incidence in individuals aged between the third and fifth decades of life
From the perspective of improving Harris hip score (HHS), our study revealed that extracorporeal shockwave (ESW) therapy and vascularized fibular grafting (VFG) technique were the best two options for hip preservation treatments in terms of improving HHS
core decompression (CD) is a standard technique widely used in patients with early-stage ONFH, which helps to decrease intraosseous pressure in the femoral head, reestablish vascular flow, and relieve pain [19]
Summary
Osteonecrosis of the femoral head (ONFH) is a debilitating disorder with a considerably high incidence in individuals aged between the third and fifth decades of life. ONFH is histologically characterized by insufficient supply of blood, death of osteocytes, and bone marrow cells, as well as progressive structure damage of involved bones, which typically follows a progressive course leading to femoral head collapse and hip joint destruction. How to retard the progression of ONFH is always a research hotspot. The principle of ONFH treatment includes the termination of pathologic progression and the restoring of weightbearing capacity. The treatment and management for ONFH consists of conservative and surgical approaches. Some RCT researches were designed to compare different surgical interventions for ONFH, including CD, DD, bone transplantation (VFG, FVFG, VIPBG, and IFHG), BioMed Research International
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