Treatment Of Femoral Head Osteonecrosis Research Articles

The efficacy of Denosumab in the treatment of femoral head osteonecrosis: a retrospective comparative study

The present study aimed to compare clinical and radiological differences of ONFH patients who were treated with denosumab, and a control group. A total of 178 patients (272 hips) with symptomatic, nontraumatic ONFH were divided into a denosumab group (98 patients, 146 hips) and a control group (80 patients, 126 hips). Patients in the denosumab group received a 60 mg subcutaneous dose of denosumab every 6 months. For the clinical assessments, Harris hip scores (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated. Plain radiographs and MRI were performed before and a minimum of 1 year after administration of denosumab, which were evaluated for radiological results including femoral head collapse (≥ 2 mm) and volume change of necrotic lesion. Femoral head collapse occurred in 36 hips (24.7%) in the denosumab group, and 48 hips (38.1%) in the control group, which was statistically significant (P = 0.012). Twenty-three hips (15.8%) in the denosumab group and 29 hips (23%) in the control group required THA, which showed no significant difference (P = 0.086). At the final follow-up, 71.9% of hips in the denosumab group had a good or excellent HHS compared with 48.9% in the control group, showing a significant difference (P = 0.012). The denosumab group showed a significantly higher rate of necrotic lesion volume reductions compared with the control group (P < 0.001). Denosumab can significantly reduce the volume of necrotic lesions and prevent femoral head collapse in patients with ARCO stage I or II ONFH.

Modified Lightbulb Non-Vascularized Bone Grafting Technique for Osteonecrosis of the Femoral Head.

Multiple techniques for non-vascularized bone grafting for the treatment of femoral head osteonecrosis have been proposed with varying degrees of success. The success of these procedures may be improved with the use of ancillary growth and differentiation factors. The trephine (Phemister) technique allows for limited decompression of the femoral head through two percutaneous tunnels, while the direct approach through the femoral head ("trapdoor" technique) may result in damage to the articular cartilage. Herein we provide our modified "lightbulb" technique to decompress the femoral head through a window at the femoral head-neck junction that provides excellent, direct access to the osteonecrotic lesion. Adjuvant, non-vascularized bone graft, comprised of bone marrow aspiration concentrate (BMAC) and open matrix bone graft (MagnetOs Flex Matrix, Kuros Bioscience, Bilthoven, Netherlands) is a unique fibrillar and flexible structure that provides bone induction and further structural support to create a favorable environment for bone formation and healing. This is a straight-forward, hip-preserving, surgical technique that may be used for symptomatic management to delay, or potentially obviate, the need for total hip arthroplasty in patients who have medium- to large-sized or early-collapse lesions of the femoral head.

Expert consensus on clinical drug prevention and treatment of osteonecrosis of the femoral head(2022)

With the in-depth understanding of osteonecrosis of femoral head (ONFH), and more and more patients seeking medical treatment in the early stage of the disease, surgical treatment of femoral head necrosis alone is no longer sufficient for the current treatment of patients' demand, how to rationally and effectively apply drugs to strengthen the early prevention and treatment of femoral head necrosis and delay the progression of disease is becoming more and more important. This article combines the latest expert consensus and evidence-based medical evidence on the principles of ONFH diagnosis and treatment in Chinese and Western medicine at home and abroad, combined with domestic actual clinical application experience, and is organized by experts from Association Related to Circulation Osseous Chinese Microcirculation Society (CSM-ARCO) to write this consensus, focusing on the types of ONFH drugs, the characteristics, safety, rationality and basic principles of drug use provide reference opinions for the safe, reasonable, standardized and effective drug use of medical institutions at all levels. This consensus is only an expert guideline based on literature and clinical experience, not as a requirement for mandatory implementation, let alone as a legal basis. The clinical practice could be tailored to the actual local conditions to develop appropriate prevention and treatment measures for patients.

Study on The Treatment of Osteonecrosis of The Femoral Head Based on The Classic Theory of “Blood Stasis Removal - Regeneration Bone - Fusion”

Objective Based on Traditional Chinese Medicine (TCM) classics, this paper, by searching the literature on the treatment of femoral head necrosis with TCM, aims to explain the essence of the theory of “blood stasis removal - regeneration bone - fusion”, analyze the development of modern Chinese medicine in the treatment of osteonecrosis of femoral head (ONFH), and provide new ideas for the treatment of ONFH with integrated traditional Chinese and western medicine. Methods CNKI, PubMed, Wanfang and VIP databases were searched by computer to collect literature research on the theory of “blood stasis removal - regeneration bone - fusion” and the treatment of ONFH with integrated TCM Western medicine. Based on content analysis and bibliometric analysis, the modern integrated traditional Chinese and western medicine literature database of treating ONFH with the theory of “removing blood stasis and generating bone” was established and analyzed. Results Based on the theory of “blood stasis removal - regeneration - bone fusion”, this paper found that the TCM treatment of ONFH has the clinical effect of promoting blood circulation and removing blood stasis. The essence of the modern medicine of the theory of “blood stasis removal - regeneration - bone fusion” is to eliminate the microcirculation disorders caused by microvascular regeneration and hypoperfusion, so as to promote bone regeneration, which coincides with the treatment of ONFH by western medicine. Conclusions The theory of “blood stasis removal - regeneration - bone fusion” in modern Chinese medicine has a certain scientific and valuable value, which is worth more scientific research in the future.

Research status and progress of bone marrow mesenchymal stem cells for osteonecrosis of femoral head

Osteonecrosis of femoral head (ONFH) is a progressive, destructive disorder with no targeted treatment currently available. The etiology of this disease is complex and the pathogenesis is not clear. The main clinical manifestations are hip pain and mobility dysfunction, which threatens human health to a large extent. If not timely intervention and treatment in the early and middle stages of ONFH, femoral head deformation and even collapse are easy to occur, seriously affecting the prognosis of patients. Therefore, early identification and treatment of ONFH is very important. With the development and maturity of regenerative medicine and tissue engineering technologies, studies have shown that Bone marrow mesenchymal stem cells (BMSCs) combined with cardiac decompression, autologous bone transplantation, arterial interventional therapy, and tissue engineering techniques, it has certain curative effect on early and middle stage ONFH. This paper mainly discusses the research status and progress of BMSCs in the treatment of ONFH, in order to provide theoretical basis for the treatment of ONFH with BMSCs.

Modified technique of percutaneous core decompression with flexible reamers and percutaneous iliac bone graft harvesting for treatment of femoral head osteonecrosis

Avascular necrosis of the femoral head (ANFH) is a debilitating disease most commonly affecting young and middle-aged people. Most often leading to a significant articular disability, ultimately needing a total hip replacement. Early diagnosis and effective joint-preserving surgical treatments are urgently needed for patients with early stage ANFH. We would like to report a minimally invasive modified technique of percutaneous core decompression using flexible reamers and percutaneous iliac bone graft harvesting to treat the early stage of femoral head osteonecrosis.

Analysis of peripheral bone reconstruction after the failure of hip osteonecrosis treatment with porous tantalum rod implantation.

Failure of porous tantalum rod (PTR) implantation in treating early osteonecrosis of femoral head (ONFH) has been frequently reported, but the underlying mechanism remains uncertain, which raised the concern of its efficacy. The study aimed to discuss the underlying mechanism from the perspectives of bone reconstruction and pathological changes. Five patients with PTR implantation experienced total hip arthroplasty (THA) due to recurrent pain, whose femoral heads were collected as "tantalum group." Normal (fracture) and necrotic femoral heads were respectively collected (both n = 5) after THA. The bone quality and structure, biomechanical properties, and histopathological features were analyzed by micro-CT scanning, mechanical measurement, and histological examination. Both the tantalum group and necrotic group had significantly poorer bone quantity and quality than the normal group. Three-dimensional imaging reconstruction showed that the trabeculae of the tantalum group were poorest in quality. Significant differences in terms of bone quality, structure, and biomechanical properties were present between the inside and outside regions around PTR, which revealed abnormal bone reconstruction. Biomechanical analysis revealed inferior properties in the tantalum group and necrosis group. H&E staining demonstrated neutrophil infiltration among the peripheral trabeculae around PTR, and the inflammation cells were significantly more abundant than that in the normal and necrosis groups. Abnormal bone reconstruction around PTR was an important cause for failure of PTR implantation in the treatment of ONFH, which was related to biomechanical stress distribution and chronic inflammation infiltration. Insufficient biomechanical support and inflammatory trabeculae edema might account for the recurrent pain.

Trends in Surgical Treatment of Femoral Head Osteonecrosis in South Korea: An Analysis Using Nationwide Claims Database.

Osteonecrosis of the femoral head (ONFH) involves young or middle-aged adults, and its incidence is increasing along with increasing use of steroids in the management of organ transplantation and adjuvant therapy for malignant neoplasms. To date, no pharmacological agent has been proven to prevent or retard the progression of ONFH, and surgical procedures including joint preservation procedures and hip arthroplasties are main treatments for the disease. Although ONFH is the most common or second most common disease for hip arthroplasty in East Asian countries, the trend of surgical procedures in this region remains unknown. Thus, we evaluated trends in surgical treatment of the disease in South Korea. We identified patients with ONFH from the Korean Health Insurance Review and Assessment (HIRA) database, a nationwide medical claims database of South Korea, between January 2007 and December 2018 and calculated the proportions of following surgical procedures at each year: total hip arthroplasty (THA), hemiarthroplasty (HA), core decompression/multiple drilling, femoral osteotomy, and vascularized bone grafting. The total number of procedures increased from 3,824 in 2007 to 6,929 in 2018. Overall, the rate of THA (86%) was far greater than other procedures. From 2007 to 2018, the percentage of THA among the procedures increased from 80% to 91%, while that of joint preservation procedures decreased from 11% to 5%. The total number of surgical procedures performed for ONFH increased and the percentage of THA increased, while that of joint preservation procedures decreased from 2007 to 2018 in South Korea.

A novel device for treatment of osteonecrosis of femoral head: Feasibility and preliminary efficacy of animal study.

BackgroundInterruption of blood supply will lead to necrosis of body tissues, such as osteonecrosis of femoral head (ONFH). Vascularization has always been regarded as one of the biggest challenges in tissue engineering. In the current study, a novel device was proposed to reconstruct blood supply of necrotic femoral head.MethodsCryo-insult with liquid nitrogen method was adopted to establish the ONFH model. In experimental group, a novel scaffold carrying vascular bundle was implanted into the necrotic femoral head after decompression and the transplanted vascular bundles were anastomosed with the existing blood vessels around the hip. In control group, a traditional porous scaffold was inserted alone without vessels. Feasibility of this strategy was verified by animal experiments. Micro-CT analysis and histological evaluation were performed to investigate its preliminary efficacy.ResultsFeasibility of this innovative treatment strategy had been successfully verified in animal experiments. In the area of necrosis repair, more bone tissue grew into the scaffold in experimental group than the control group evaluated by Micro-CT (three months: 29.66% VS 20.35%, P＜0.05; six months: 30.47% VS 25.10%, P＜0.05) and histological analysis (24.71% VS 16.45%, P＜0.05 ​at three months; 31.01% VS 20.60%, P＜0.05 ​at six months). Implanted vascular bundles had the potential to branch out many branches in the osteonecrosis repair area to facilitate blood supply reconstruction and bone repair.ConclusionsThis study proposed a novel device with clinical application prospects in the treatment of ONFH. It has the potential to provide new possibilities for rebuilding the blood supply of femoral head and repairing osteonecrosis.Translational potential statementThe novel device proposed in this study has the potential to be applied to the treatment of early femoral head necrosis.

Diagnosis and Treatment of Femoral Head Osteonecrosis: A Protocol for Development of Evidence-Based Clinical Practice Guidelines

Introduction: There are many treatment options for patients who have osteonecrosis of the femoral head (ONFH) and management strategies vary widely both among and within individual countries. Although many researchers have attempted to elucidate the optimal strategies for managing this disease, the lack of large-scale randomized control trials and the lack of agreement on disease staging have curtailed the development of clear-cut guidelines. Materials and Methods: The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: 1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; 2) What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and 3) What is the best treatment strategy for patients who have post-collapse disease? The Patient, Intervention, Comparison, and Outcome (PICO) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH. Discussion: It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.

Retraction Note: High failure rate after Beta-tricalcium phosphate grafting for the treatment of femoral head osteonecrosis: a retrospective analysis

Non-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. From 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. The 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. Our 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.

Potential roles of extracellular vesicles in osteonecrosis of femoral head: A systematic review.

Extracellular vesicles (EVs), have been utilised for the diagnosis and treatment of osteonecrosis of femoral head (ONFH). Hence, we aimed to review the available evidence on the potential roles of EVs in ONFH systematically. The PubMed, EMBASE, and Science Citation Index databases were searched exhaustively from inception to June 2020. All in vitro and in vivo studies on the use of EVs in ONFH diagnosis and treatment were included. The final analysis included 14 studies. These studies were categorised according to the cell source, target cell types, secreted product types, production method, storage, and study design. The animal model, together with the ONFH induction method, used in the in vivo studies was also considered. For in vivo studies, effects on cellular proliferation and apoptosis and bone and vascular tissues and biomarkers for ONFH diagnosis were assessed, whereas in the in vitro studies, effects on EVs internalization; proliferation, viability, and migration; osteogenic and adipogenic differentiation; apoptosis; and angiogenesis were evaluated. Both in vitro and in vivo studies showed promoting effects of EVs on proliferation, osteogenic differentiation, and angiogenesis and inhibitory effects on apoptosis and adipogenic differentiation in both glucocorticoid-induced and traumatic ONFH models. Additionally, EVs in blood showed diagnostic potential for ONFH. This systemic review provides a deeper understanding of the role of EVs, thereby facilitating the development of novel therapeutic strategies.

Imaging Observation of Nano-Artificial Bone in the Repair of the Defect in Osteonecrosis of the Femoral Head.

To observe the effect of nano-artificial bone and bone marrow mesenchymal stem cells (BMSCs) in the treatment of femoral head osteonecrosis. The bilateral femoral head internal bone defect model was established and divided into three groups. Group A was used to make the defect without filling any material as the control, group B was only filled with nano-artificial bone, and group C was filled with composite materials of nano-artificial bone and bone marrow mesenchymal stem cells. The femoral head was examined using radiography and high-resolution focused 48-slice computed tomography (CT) at 12 weeks after implantation. A significant difference was found between groups B and C in the aspect of repairing the defect in osteogenesis of the femoral head as compared with the control group. Nano-collagen-based bone has strong osteogenic and osteogenic effects and is a good graft material for repairing bone defects of the femoral head. The use of bone marrow mesenchymal stem cells can promote the repair of bone defects, which is of great value in the treatment of osteonecrosis of the femoral head.

Research progress in osteonecrosis of femoral head following femoral intertrochanteric fractures in adults

To summarize the research progress of osteonecrosis of femoral head (ONFH) following femoral intertrochanteric fractures in adults. Relevant literature at home and abroad was extensively reviewed to summarize the pathogenesis, high-risk factors, and treatment of ONFH after femoral intertrochanteric fracture in adults. ONFH after femoral intertrochanteric fracture mostly occurs within 2 years after operation, with a lower incidence. At present, it is believed that comminuted and large displacement fractures caused by high-energy injuries, fracture line close to the base of neck, excessive external rotation deformity, improper intramedullary nail entry points, and rough intraoperative manipulating may injury the deep branch of the medial circumflex femoral artery, causing ONFH. Hip replacement is the main treatment for necrosis, which can achieve good results. Addressing the above risks, excessive external rotation, overstretching, and rough manipulating should be avoided. Anatomical reduction should be performed during the operation, the nail entry point should be accurate and avoid repeated drilling and thermally bone necrosis.

Administration of mircoRNA-135b-reinforced exosomes derived from MSCs ameliorates glucocorticoid-induced osteonecrosis of femoral head (ONFH) in rats.

Exosomes were found to exert a therapeutic effect in the treatment of osteonecrosis of the femoral head (ONFH), while miR‐135b was shown to play an important role in the development of ONFH. In this study, we investigated the effects of concomitant administration of exosomes and miR‐135b on the treatment of ONFH. A rat mode of ONFH was established. TEM, Western blotting and nanoparticle analysis were used to characterize the exosomes collected from human‐induced pluripotent stem cell–derived mesenchymal stem cells (hiPS‐MSC‐Exos). Micro‐CT was used to observe the trabecular bone structure of the femoral head. Real‐time PCR, Western blot analysis, IHC assay, TUNEL assay, MTT assay and flow cytometry were performed to detect the effect of hiPS‐MSC‐Exos and miR‐135b on cell apoptosis and the expression of PDCD4/caspase‐3/OCN. Moreover, computational analysis and luciferase assay were conducted to identify the regulatory relationship between PDCD4 mRNA and miR‐135b. The hiPS‐MSC‐Exos collected in this study displayed a spheroidal morphology with sizes ranging from 20 to 100 nm and a mean concentration of 1 × 1012 particles/mL. During the treatment of ONFH, the administration of hiPS‐MSC‐Exos and miR‐135b alleviated the magnitude of bone loss. Furthermore, the treatment of MG‐63 and U‐2 cells with hiPS‐MSC‐Exos and miR‐135b could promote cell proliferation and inhibit cell apoptosis. Moreover, PDCD4 mRNA was identified as a virtual target gene of miR‐135b. HiPS‐MSC‐Exos exerted positive effects during the treatment of ONFH, and the administration of miR‐135b could reinforce the effect of hiPS‐MSC‐Exos by inhibiting the expression of PDCD4.

Treatment of Femoral Head Osteonecrosis (Stages 2B, 3 Ficat) Through Open Direct Core Decompression by Allograft Impaction and Light Bulb Technique.

Femoral head avascular necrosis is the cause of paralyzing status of youth population. Initial diagnosis is the main element in treating the disease. Bone grafting and core decompression are the approved cures at the early steps of the disease. Hip replacement in a total manner is the common cure in the final stages. The optimal treatment in the intermediate stages is partially disputable. We investigated several patients with femoral head osteonecrosis cured with impacted cancellous allograft and open core decompression using the lightbulb technique. A total of 46 patients (58 hips) suffering from femoral head osteonecrosis were evaluated in this cross-sectional study. Patients were classified into two groups: A (stage 2B Ficat) and B (stage 3 Ficat) to be treated with the impaction of cancellous allograft and by open core decompression. Radiographic results, demographic data, and range of hip joint motions were recorded. The patients were assessed through employing the Harris hip score (HHS) and visual analogue scale (VAS) index prior to operation and over five years following surgery. We also studied radiographic alterations of femoral head. The means of HHS and VAS were developed following the operation. Radiographic outcomes promoted in both groups, however, it was better in group A. 12 (40%) and six (22%) hips (40%) in groups A and B, respectively displayed developed stages following the operation. The hip ROM was enhanced with the mean of 15-20 degrees (P<0.005). Open core decompression combined with allograft impaction sounds to be influential in the developing steps of femoral head necrosis and leads to joint discomfort and diminished pain improving ROM of the hip joint and meanwhile procrastinating the worsening of the disease.

Expert consensus on prevention and treatment strategies for osteonecrosis of femoral head during the prevention and control of novel coronavirus pneumonia (2020)

Novel coronavirus pneumonia is a new type of respiratory infectious disease that has rapidly spread in many countries or regions around the world. The World Health Organization (WHO) named it "coronavirus disease 2019 (COVID-19)". Glucocorticoids (GC) have certain application value in patients with COVID-19, but they need to be used with caution and strict indications and dosage. Application of large doses of GC can also cause osteonecrosis of femoral head (ONFH). On the basis of the latest literature and evidence-based medical evidence on the fight against COVID-19 epidemic and steroid ONFH diagnosis and treatment, the Bone Circulation and Osteonecrosis Professional Committee, Shockwave Medical Specialty Committee of Chinese Research Hospital Association organized Chinese bone necrosis related experts to jointly write this consensus, focusing on the prevention strategy and the protective management measures in the ONFH diagnosis and treatment process during the prevention and control of COVID-19, which can provide reference for hospitals at all levels to carry out early prevention and treatment of ONFH.

Modified technique of advanced core decompression for treatment of femoral head osteonecrosis.

Osteonecrosis of the femoral head (ONFH) is a destructive condition most commonly affecting young and middle-aged patients. The leading consequence of ONFH is often a significant articular disability. Effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease. To introduce a new surgery procedure called percutaneous expanded core decompression and mixed bone graft technique, which is a new way of joint-preserving surgical treatments. The clinical data of 6 patients with ONFH diagnosed and treated with the procedure called percutaneous expanded core decompression and mixed bone graft technique at The First Hospital of Qiqihar from March 2013 to August 2019 were retrospectively analyzed; the follow-up ended in December 2019. There were 6 male patients with an average age of 43 years in our study. Gratifying results have been obtained from the comparison of Harris hip score, visual analogue scale, and imaging examination before and after operation. This new modified technique is simple, safe, and reliable. No serious perioperative complications were observed in our cases. Advantages of the single blade expandable reamer are obvious. The adjuvant substance is inexpensive and easy to obtain. Thus, this technique is an effective joint-preserving surgical treatment for patients with early stage of ONFH.

Аутологичные мезенхимальные стволовые клетки для лечения остеонекроза головки бедра

Аутологичные мезенхимальные стволовые клетки для лечения остеонекроза головки бедра

Comparison of surgical dislocation and impacting bone graft and surgical dislocation and rotational osteotomy for the treatment of ARCO III femoral head necrosis.

Hip preserving procedures are still a challenge in late-stage osteonecrosis of femoral head (ONFH) patients. We aimed to compare the clinical outcomes of surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy for treatment of ONFH in Association Research Circulation Osseous (ARCO) stage III patients.We retrospectively reviewed 30 ARCO stage III patients (33 hips) who had surgical dislocation and impaction bone graft or surgical dislocation and rotational osteotomy in our center from June 2012 to December 2017. Baseline characteristics, clinical evaluation using Harris score and radiologic evaluation up to 12 months after surgery were recorded and compared.Fifteen patients (17 hips) were in the surgical dislocation and impaction bone graft group and 15 patients (16 hips) were in the surgical dislocation and rotational osteotomy group. No significant differences in age, gender, etiology, ARCO stage, duration of illness, operation time, and length of hospitalization were observed between the 2 groups. Compared to preoperation Harris score, the Harris score of 6 months postoperation and 12 months postoperation significantly improved. At 12 months postoperation, the excellent and good rate was 76.5% in the impaction bone graft group and 87.5% in the rotational osteotomy group. No significant difference in Harris scores was detected in the 2 groups.Surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy had satisfactory 1-year efficacy for ARCO III ONFH patients. Surgical dislocation and rotational osteotomy had better short-term efficacy than surgical dislocation and impaction bone graft.