Abstract
The purpose of this study was to compare the clinical outcomes of impacted bone graft with or without recombinant human bone morphogenetic protein-2 (rhBMP-2) for osteonecrosis of the femoral head (ONFH). We examined the effect of bone-grafting through a window at the femoral head-neck junction, known as the “light bulb” approach, for the treatment of ONFH with a combination of artificial bone (Novobone) mixed with or without rhBMP-2. A total of 42 patients (72 hips) were followed-up from 5 to 7.67 years (average of 6.1 years). The patients with and without BMP were the first group (IBG+rhBMP-2) and the second group (IBG), respectively. The clinical effectiveness was evaluated by Harris hip score (HHS). The radiographic follow-up was evaluated by pre-and postoperative X-ray and CT scan. Excellent, good, and fair functions were obtained in 36, 12, and 7 hips, respectively. The survival rate was 81.8% and 71.8% in the first and second group, respectively. However, the survival rate was 90.3% in ARCO stage IIb, c, and only 34.6% in ARCO stage IIIa(P<0.05). It was concluded that good and excellent mid-term follow-up could be achieved in selected patients with ONFH treated with impacted bone graft operation. The rhBMP-2 might improve the clinical efficacy and quality of bone repair.
Highlights
Non-traumatic osteonecrosis of the femoral head (ONFH) frequently affects patients between 20 and 50 years of age, and may be progressed to femoral head collapse within 1 to 5 years
We reported the middle-term efficacy of treating ONFH with Light Bulb procedure and impacted bone grafting that were performed in our center
Note: * P,0.05 The statistical value was derived from chi-square test; P,0.05 between IIb and IIc as well as IIc and IIIa; statistical difference was found between Type L1 and Type L3, and there were significant statistical differences between pre-and post-operation Harris score, but no statistical differences between impacted bone grafting (IBG)+BMP2 and IBG groups. doi:10.1371/journal.pone.0100424.t002
Summary
Non-traumatic osteonecrosis of the femoral head (ONFH) frequently affects patients between 20 and 50 years of age, and may be progressed to femoral head collapse within 1 to 5 years. In 1994, Rosenwasser et al initially brought forth the concept of the ‘‘Light Bulb procedure’’, in which the necrotic lesion was replaced by the bone grafting via the window on the femoral head-neck junction without any damage to the joint cartilage [3]. This procedure provided strong structural support for the femoral head, amended the morphology of the femoral head to a certain extent, and averted the further collapse of the femoral head. It had several advantages, including: being a simple surgical technique, low incidence of complication, and short duration of operation
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