Percutaneous autologous impaction bone graft for advanced femoral head osteonecrosis: a retrospective observational study of unsatisfactory short-term outcomes

Yutaka Kuroda,Koji Goto,Shuichi Matsuda,Manabu Nankaku,Toshiyuki Kawai,Yaichiro Okuzu

doi:10.1186/s13018-021-02288-7

Abstract

BackgroundHalf of osteonecrosis of the femoral head (ONFH) patients suffer femoral head collapse at initial diagnosis, and more than half are bilaterally affected. This study developed a percutaneous autologous impaction bone graft (IBG) technique as a modification of core decompression (CD). We also summarized the short-term results and treatment efficacy of percutaneous autologous IBG in advanced ONFH.MethodsTwenty patients (12 males, 8 females) with nontraumatic, postcollapse ONFH except one case underwent CD (10-mm core diameter) and reverse IBG. Radiological changes of the ONFH stage and type were analyzed. Survival analysis using Kaplan–Meier estimates was performed with conversion to total hip arthroplasty (THA) as the endpoint. In addition, the Harris hip score (HHS) and University of California, Los Angeles (UCLA) activity rating scale were evaluated.ResultsPercutaneous autologous IBG was performed successfully, with an average operation time of < 1 h and small blood loss, and 7 patients (35%) needed conversion to THA at an average of 17 months postoperatively. We observed radiological progressive change in 60% of the patients during a mean observation period of 3 years. The mean clinical scores, except data recorded, after THA significantly improved (before vs. after 3 years: UCLA activity score, 3.7 vs. 5.2 [P = 0.014]; HHS, 57.6 vs. 76.5 points [P = 0.005]). In addition, 6 patients showed radiological progression but no clinical deterioration.ConclusionsPercutaneous autologous IBG was technically simple and minimally invasive, but short-term results were unsatisfactory for advanced ONFH. Indications for this procedure should be carefully examined to improve it in order to enable bone formation.

Highlights

Half of osteonecrosis of the femoral head (ONFH) patients suffer femoral head collapse at initial diagnosis, and more than half are bilaterally affected
This study developed a percutaneous autologous impaction bone graft (IBG) technique as a modification of core decompression (CD) and the Phemister method
Radiological progression was observed in 12 patients (60%), including the 7 patients converted to total hip arthroplasty (THA), while 8 patients showed no stage change since surgery

Summary

Introduction

Half of osteonecrosis of the femoral head (ONFH) patients suffer femoral head collapse at initial diagnosis, and more than half are bilaterally affected. This study developed a percutaneous autologous impaction bone graft (IBG) technique as a modification of core decompression (CD). We summarized the short-term results and treatment efficacy of percutaneous autologous IBG in advanced ONFH. With increasing use of THA, the development of regenerative medicine combining CD with cell transplantation, bone substitute, and growth factors has shown promise, especially for early to stage 2 ONFH, prior to femoral head collapse [1, 2, 4,5,6], with THA being the final surgical option for ONFH. Half of advanced (stage 3 or greater) ONFH patients already have femoral head collapse at initial diagnosis [12], and more than half are bilaterally affected [1, 5, 12]. We summarized the short-term (3-year) results and treatment efficacy of percutaneous autologous IBG in advanced ONFH

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Results

Discussion

Conclusion