Abstract
PurposeThe aim of this study was to determine mid-and-long term follow-up results of patients with early femoral head osteonecrosis who were treated by modified free vascularized fibular grafting combined with core decompression and bone grafting.MethodsForty-four patients at early ONFH were included in this study. Visual analog scale (VAS) pain scores, range of hip motion (ROM), and Harris hip score (HHS) were recorded to assess the clinical outcome; Western Ontario McMaster Osteoarthritis index (WOMAC) scores and Short Form 36 health survey (SF-36) were conducted to measure the living quality; X-ray film or magnetic resonance imaging (MRI) was used to evaluate radiographic progression; survivorship was defined as patients did not undergo the total hip arthroplasty (THA) or fusion at the last follow-up. Median follow-up was 7.4 years (6–8.2 years).ResultsThe mean VAS score, ROM, and HHS were significantly improved at the final follow-up compared with preoperative values (p < 0.001). Health assessment including WOMAC scores and SF-36 were also better than those preoperatively (p < 0.001). Seven patients progressed to Ficat III and the four patients progressed to Ficat IV with osteoarthritis. Eight patients who cannot tolerate the pain and had poor living quality underwent THA.ConclusionModified non-vascularized allogeneic fibula Grafting combined with core decompression and bone grafting could improve the clinical outcomes and enhance the quality of life for patients with early ONFH.
Highlights
Osteonecrosis of the femoral head (ONFH), characterized by reduced local blood flow, death of the osteocytes, and the bone marrow, is a frequently disease occurring in young individuals, which can lead to a progressive destruction of bone architecture, subchondral fracture, extensive hip pain, and loss of joint function [1]
Most patients still have to refer to operation for Changjun et al Journal of Orthopaedic Surgery and Research (2020) 15:116 further treatment, and operation methods are various, ranging from core decompression, fibular, or iliac bone grafting to Tantalum rod implantation [6,7,8,9]
Core decompression combined with tantalum rod placement or fibular grafting is an effective measure to support the subchondral architecture with a comparatively good success rate, but little bone ingrowth and insufficient mechanical support of subchondral bone can still be seen in some cases [12, 13]
Summary
Osteonecrosis of the femoral head (ONFH), characterized by reduced local blood flow, death of the osteocytes, and the bone marrow, is a frequently disease occurring in young individuals, which can lead to a progressive destruction of bone architecture, subchondral fracture, extensive hip pain, and loss of joint function [1]. Most patients still have to refer to operation for Changjun et al Journal of Orthopaedic Surgery and Research (2020) 15:116 further treatment, and operation methods are various, ranging from core decompression, fibular, or iliac bone grafting to Tantalum rod implantation [6,7,8,9]. It has been proved that free vascularized fibular grafting can improve vascularity compared with core decompression in the treatment of femoral head osteonecrosis, which is effective on pain-relieving and function recovering [9]. Considering the complexity of free vascularized fibula graft, impracticality for community hospitals, and high costs of tantalum rod implantation, an effective and inexpensive method should be found for some less affluent population to delay the progression of ONFH and protect the femoral head before it collapses
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