Abstract
BackgroundThis study aimed to evaluate the clinical efficacy of femoral head and neck fenestration combined with autologous bone mixed with β-tricalcium phosphate porous bioceramic bone (light bulb procedure) through Orthopdische Chirurgie München approach (OCM approach) for pre-collapse non-traumatic osteonecrosis of the femoral head(ONFH).MethodsThe clinical data of 47 patients (47 hips) with ONFH were retrospectively reviewed. The Harris hip score (HHS) was used to evaluate the clinical outcomes. Imaging was assessed by X-ray. Clinical failure was defined as postoperative total hip arthroplasty (THA) or the HHS was poor (< 70). The Kaplan–Meier survival curve was used to conduct a univariate analysis of risk factors. The analysis factors included gender, age, International Association Research Circulation Osseous (ARCO) stage, etiology, body mass index (BMI), 25-hydroxyvitamin D (25(OH)D), and type I collagen carboxy-terminal peptide (CTX). The COX multivariate risk model was used to analyze the risk factors.ResultsAll the 47 hips were followed up for 24–58 months, with an average of 45 months. The Harris score (76.29 ± 10.38) at the last follow-up was significantly higher than the preoperative HHS (64.45 ± 2.93) (P < 0.05). The postoperative HHS was excellent with a success rate of 36.17%. Postoperative imaging evaluation showed that 9 hips improved, 28 hips stabilized, and 10 hips progressed. Moreover, 17 out of 47 hips were defined as a postoperative clinical failure and the success rate was 63.83%. 25(OH)D and preoperative ARCO stage were risk factors for postoperative clinical failure (P < 0.05). The COX multivariate risk model analysis showed that IIIA stage was an independent risk factor for postoperative clinical failure (P < 0.05).ConclusionsThe head and neck fenestration and bone grafting via the OCM approach in the treatment of non-traumatic ONFH in the pre-collapse stage can achieve good clinical outcomes. 25(OH)D deficient patients and ARCO IIIA patients had a higher failure rate of bone graft using this approach.
Highlights
Osteonecrosis of the femoral head (ONFH) is a frequent and refractory disease in the field of orthopedics that still requires comprehensive exploration
The head and neck fenestration and bone grafting via the OCM approach in the treatment of nontraumatic ONFH in the pre-collapse stage can achieve good clinical outcomes. 25(OH)D deficient patients and Association Research Circulation Osseous (ARCO) IIIA patients had a higher failure rate of bone graft using this approach
The present study aimed to evaluate the results of the OCM approach through the functional recovery quality, clinical results, imaging, and survival rate of patients with non-traumatic ONFH before the collapse
Summary
Osteonecrosis of the femoral head (ONFH) is a frequent and refractory disease in the field of orthopedics that still requires comprehensive exploration. ONFH is a decrease in blood flow to the femoral head, which causes partial death of bone cells and bone marrow components, followed by repair. It subsequently causes osteonecrosis, resulting in structural changes in the femoral head and even collapse, causing pain and dysfunction of the hip joint [1, 2]. ONFH is most common in 20- to 50-year-old patients. ONFH patients usually suffer from femoral head collapse without intervention. This study aimed to evaluate the clinical efficacy of femoral head and neck fenestration combined with autologous bone mixed with β-tricalcium phosphate porous bioceramic bone (light bulb procedure) through Orthopdische Chirurgie München approach (OCM approach) for pre-collapse non-traumatic osteonecrosis of the femoral head(ONFH)
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