Abstract
BackgroundNon-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH). Among the various types of bone grafting techniques, “light-bulb” procedure grafting with synthetic bone substitute is an attractive option. We aimed to assess the effectiveness of using beta-tricalcium phosphate (β-TCP) for the treatment of pre-collapse and early post-collapse lesions NONFH.MethodsFrom April 2010 to June 2014, 33 patients (47 hips) with NONFH were treated using the afore-mentioned technique. The clinical and radiological outcomes were recorded and compared statistically between pre- and post-operation. Harris hip score (HHS) was used to evaluate the clinical results, and Association Research Circulation Osseous (ARCO) stage was applied to assess the radiological outcomes.ResultsThe 5-years survival rate of using β-TCP grafting was accounting for 25.5%. HHS was decreased from 78.47 to 52.87 points, and a very significant worsening of radiological results were revealed (P < 0.05). Two hips collapsed more than 2 mm were awaiting for THA, and 33 of the 47 hips had converted to THAs in an average time to failure of 24.24 months postoperatively. Meanwhile, only 4 hips survived without collapse, and 8 hips collapsed less than 2 mm. After surgery, the time onset of head collapse was 3.65 months on average, and the first conversion to THA was performed at 5 months postoperative.ConclusionsOur results suggest that “light-bulb” procedure grafting with β-TCP sticks presented with a high failure rate in the early postoperative period. It is not proposed for the treatment of pre-collapse and early post-collapse lesions NONFH.
Highlights
Non-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH)
Our results suggest that “light-bulb” procedure grafting with Beta-tricalcium phosphate (β-TCP) sticks presented with a high failure rate in the early postoperative period
Non-traumatic osteonecrosis of femoral head (NONFH) is a devastating condition associated with apoptosis of the osteocytes and the bone marrow, which has a natural history of relentless progressive necrosis leading to fracture of subchondral bone plate, collapse of femoral head articular surface, and eventual premature osteoarthritis of hip [1, 2]
Summary
Non-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH). Non-traumatic osteonecrosis of femoral head (NONFH) is a devastating condition associated with apoptosis of the osteocytes and the bone marrow, which has a natural history of relentless progressive necrosis leading to fracture of subchondral bone plate, collapse of femoral head articular surface, and eventual premature osteoarthritis of hip [1, 2]. Therapeutic methods have been developed for the treatment of NONFH can be assigned into three categories: non-surgical management, head-preserving surgery and hip-replacing procedures. Many head-preserving procedures are proposed to protect the involved hip from collapse, which include a large single or multiple small holes core decompression (CD) [4, 5], osteotomies in various types [6, 7], and bone grafting in different methods [8, 9]
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