Abstract
BackgroundOsteonecrosis of the femoral head (ONFH) is a debilitating condition. Vascularized iliac bone graft (VIBG) is a joint-preserving surgery to improve blood supply to the avascular portion of the femoral head which may delay secondary osteoarthritis and total hip arthroplasty (THA). However, whether VIBG will affect the subsequent THA survivorship and outcomes are still uncertain.MethodsImplant survivorship and clinical outcomes were compared between 27 patients who had undergone prior VIBG and 242 patients who had only undergone THA for ONFH. Baseline characteristics and the postoperative Harris Hip Score (HHS) were also recorded and compared between the two groups. Implant survivorship was determined using Kaplan-Meier survival analysis.ResultsThe overall implant survival for all patients who had a primary diagnosis of ONFH and eventually underwent THA was 92.9%. There was no significant difference in the implant survivorship between the group who directly received THA (survivorship of 93%) and the group which failed VIBG and was subsequently converted to THA (survivorship of 91.9%) (p = 0.71). In addition, higher THA revision rates were associated with smokers and drinkers.ConclusionsVIBG may be a reasonable option as a “buy-time” procedure for ONFH. Even if conversion to THA is eventually required, patients may be reassured that the overall survivorship and clinical outcomes may not be compromised. Patients are recommended to give up smoking and binge drinking prior to THA to increase implant survival rate.
Highlights
Symptomatic osteonecrosis of the femoral head (ONFH) is a debilitating condition that has a poorly understood pathogenesis [1]
The overall implant survival for all patients who had a primary diagnosis of Osteonecrosis of the femoral head (ONFH) and eventually underwent total hip arthroplasty (THA) was 92.9% (N = 315 of 339)
We investigated the effects of different risk factors on THA survivorship and found that percentages of implant survival of ONFH patient who underwent primary THA were much affected than patients that underwent Vascularized iliac bone graft (VIBG)+THA if they smoked or drank
Summary
Symptomatic osteonecrosis of the femoral head (ONFH) is a debilitating condition that has a poorly understood pathogenesis [1]. Primary THA as a treatment is often not expected to outlive the patient’s lifespan Procedures such as VIBG have been developed in an attempt to save the femoral head, or at least slow down the rate of progression of ONFH before its collapse. VIBG converting to THA has been reported with different reasons These include asymmetric bone healing and non-union between the graft and the necrotic subchondral bone in the weight-bearing area, and failure of revascularization of vascularized fibular graft [27, 28]. Vascularized iliac bone graft (VIBG) is a joint-preserving surgery to improve blood supply to the avascular portion of the femoral head which may delay secondary osteoarthritis and total hip arthroplasty (THA). Whether VIBG will affect the subsequent THA survivorship and outcomes are still uncertain
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