Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

Abstract

BackgroundThis study aimed to evaluate the effect of femoral head and neck fenestration combined with compacted autograft (light bulb procedure) through a direct anterior approach for early stage nontraumatic osteonecrosis of the femoral head. MethodsWe conducted a retrospective cohort study investigating 66 hips undergoing the light bulb procedure through the direct anterior approach (light bulb group) and 59 hips undergoing traditional core decompression (control group). Visual analog scale pain scores and range of hip motion were evaluated before discharge to assess the quality of functional recovery. Follow-up was conducted at 6 weeks, 3 months, 6 months, and annually after surgery until 4 years. The clinical effectiveness was evaluated by Harris hip score and the University of California Los Angeles activity-level score. Patients were followed up with postoperative X-ray and computed tomography. Survival was compared between the 2 groups by radiographic progression and receiving total hip arthroplasty. ResultsThere was no significant difference in quality of functional recovery between the 2 groups. There were no significant differences in clinical outcomes within 1 year after surgery. Patients in the light bulb group had significantly better Harris hip scores and University of California Los Angeles activity-level scores from 2 years after surgery to the end of follow-up. During the 4-year follow-up, significantly fewer patients in light bulb group had radiographic progression (22.7% vs 44.1%) or received total hip arthroplasty (15.2% vs 30.5%). ConclusionsThe light bulb procedure through a direct anterior approach offers significantly better results for the treatment of early stage nontraumatic osteonecrosis of the femoral head compared with traditional core decompression.