One-sided hip-preserving and concurrent contralateral total hip arthroplasty for the treatment of bilateral osteonecrosis of the femoral head in different stages: short-medium term outcomes

BMC Musculoskeletal Disorders

Jinlun Chen¹  Chunzhi Yi¹  Jianchun Zeng¹  Feilong Li¹  Jie Li¹  Wenjun Feng¹  Xinyu Qi¹  Yirong Zeng¹ 

[1] Department of Orthopaedic, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Airport Road 16#, Guangzhou City, 510405, Guangdong Province, China

关键词: Outcomes;    One-stage;    Total hip arthroplasty;    Impaction bone grafting;    Fibular allografting;   

Others  :  1227762
DOI  :  10.1186/s12891-015-0583-5

 received in 2014-12-01, accepted in 2015-05-15,  发布年份 2015

【 摘 要 】

Background

We aimed to evaluate the clinical and radiological short-medium term outcomes for the treatment of bilateral osteonecrosis of the femoral head (ONFH) with hip-preserving surgery of core decompression followed by tightly impaction bone grafting combining with non-vascularized fibular allografting in one hip and concurrent one-stage total hip arthroplasty (THA) in the contralateral side. We hypothesized the aforementioned surgery showed benefits of protecting the preserved hip from collapsing and thereafter THA was delayed or avoided.

Methods

We retrospectively reviewed a consecutive series of 18 non-traumatic bilateral ONFH patients (36 hips) who had undergone previous mentioned surgeries between July 2004 and June 2013. Preoperative and the last follow-up Harris Hip Score (HHS) and Visual Analogue Scale (VAS) Score were obtained for clinical outcomes evaluation and X-rays of antero-posterior and frog-leg lateral views of bilateral hips were compared for radiological outcomes assessment.

Results

All patients were telephone contacted for out-patient clinic return visit at an average follow-up time of 53.3 months (ranged from 20 months to 107 months). Of the 18 patients (15 men and 3 women), there were 5 patients were diagnosed preoperative IIB stages according to classification of the Association Research Circulation Osseuse classification (ARCO) and the remaining 13 patients were in ARCO IIIC stages. The mean age of the included patients was 40.7 years (range from 22 to 59 years). No age and followed-up time difference existed in genders. The postoperative HHS were 83.8 ± 17.9 points, and it revealed statistical significance when compared to preoperative 61.6 ± 17.0 points (p < 0.05). The VAS scores were reduced from preoperative 6.2 ± 2.0 points to postoperative 2.8 ± 2.3 points, which also manifested outcomes significance (p < 0.05). From radiological aspects, 14 patients acquired well repairmen of the necrotic areas of the femoral head. However, the other 4 patients ultimately suffered femoral head collapse, and the severe pain was gotten rid of after THA surgeries were performed.

Conclusions

The un-collapsed hip can achieve biological stability and sufficient blood supply through the hip-preserving surgery and obtain longtime repairmen of the necrotic bone as well as early non-weight-bearing function training, which benefits from distributing the whole body weight load to the hip of one-stage THA. Consequently, we recommend this sort of surgery for clinical practice trial when faced bilateral ONFH in different stages though longer time follow-up and larger samples are essentially needed to address its efficacy.

【 授权许可】

   
2015 Zeng et al.

【 图 表 】

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【 参考文献 】

• [1]Jergesen HE, Khan AS. The natural history of untreated asymptomatic hips in patients who have non-traumatic osteonecrosis. J Bone Joint Surg Am. 1997; 79(3):359-63.
• [2]Ohzono K, Saito M, Takaoka K, Ono K, Saito S, Nishina T, Kadowaki T. Natural history of non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Br. 1991; 73(1):68-72.
• [3]Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, Urbaniak JR. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect. 2003; 52:337-55.
• [4]Lee MS, Chang YH, Chao EK, Shih CH. Conditions before collapse of the contralateral hip in osteonecrosis of the femoral head. Chang Gung Med J. 2002; 25(4):228-37.
• [5]Gardniers JWM et al.. The ARCO perspective for reaching one uniform staging system of osteonecrosis. In: Bone circulation and vascularization in normal and pathological conditions. Schontens A, Arlet J, Gardneirs JWM, Hughes SPF, editors. Plenum, New York; 1993: p.375.
• [6]Zhao D, Wang B, Guo L, Yang L, Tian F. Will a vascularized greater trochanter graft preserve the necrotic femoral head? Clin Orthop Relat Res. 2010; 468(5):1316-24.
• [7]John EN. Avascular necrosis of bone: a review. Royal Soc Med. 1983; 76:681-92.
• [8]Hungerford DS. Role of core decompression as treatment method for ischemic femur head necrosis. Orthopade. 1990; 19(4):219-23.
• [9]Sugioka Y, Hotokebuchi T, Tsutsui H. Transtrochanteric anterior rotational osteotomy for idiopathic and steroid-induced necrosis of the femoral head. Indications and long-term results. Clin Orthop Relat Res. 1992; 277:111-20.
• [10]Simank H-G, Brocai DRC, Strauch K, Lukoschek M. Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis. Int Orthop. 1999; 23(3):154-9.
• [11]Yoo MC, Kim KI, Hahn CS, Parvizi J. Long-term followup of vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res. 2008; 466(5):1133-40.
• [12]Steinberg ME, Brighton CT, Corces A, Hayken GD, Steinberg DR, Strafford B et al.. Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation. Clin Orthop Relat Res. 1989; 249:199-208.
• [13]Pavlovcic V, Dolinar D, Arnež Z. Femoral head necrosis treated with vascularized iliac crest graft. Int Orthop. 1999; 23(3):150-3.
• [14]Zeng YR, He S, Feng WJ, Li FL, Li J, Jian LY, Zeng JC, Fan YG. Clinical research on the vascularized greater trochanter bone graft combined free iliac flap and impaction bone grafting therapy for osteonecrosis of the femoral head. Int Orthop. 2013; 37(3):391-8.
• [15]Phemister DB. Treatment of the necrotic head of the femur in adults. J Bone Joint Surg Am. 1949; 31A(1):55-6.
• [16]Rijnen WH, Gardeniers JW, Buma P, Yamano K, Slooff TJ, Schreurs BW. Treatment of the femoral head osteonecrosis using bone impaction grafting. Clin Orthop Relat Res. 2003; 417:74-83.
• [17]Bednarek A, Atras A, Gagala J, Kozak L. Operative technique and results of core decompression and filling with bone grafts in the treatment of osteonecrosis of the femoral head. Ortho Traumatol Rehabil. 2010; 12(6):511-8.
• [18]Marcus ND, Enneking WF, Massam RA. The silent hip in idiopathic aseptic necrosis: treatment by bone-grafting. J Bone Joint Surg Am. 1973; 55(7):1351-66.
• [19]Nelson LY, Clark CR. Efficacy of Phemister bone grafting in nontraumatic aseptic necrosis of the femoral head. J Arthroplasty. 1993; 8(3):253-8.
• [20]Buckley PD, Gearen PF, Petty RW. Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1991; 73(9):1357-64.
• [21]Smith KR, Bonfiglio M, Montgomery WJ. Non-traumatic necrosis of the femoral head treated with tibial bone-grafting: a follow-up note. Bone Joint Surg Am. 1980; 62(5):845-7.
• [22]Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG. Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am. 2003; 85-A(4):589-96.
• [23]Lih LY, Wong YC, Shih HN. One-stage hip arthroplasty and bone grafting for bilateral femoral head osteonecrosis. Clin Orthop Relat Res. 2009; 467(6):1522-8.
• [24]Arlet J. Nontruamatic avascular necrosis of the femoral head: past, present, and future. Clin Orthop Relat Res. 1992; 277:12-21.
• [25]Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of osteonecrosis of the femoral head with free vascuiarized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am. 1995; 77(5):681-94.
• [26]Zhang C, Zeng B, Xu Z, Song W, Shao L, Jing D, Sui S. Treatment of femoral head necrosis with free vascularized fibular grafting: a preliminary report. Microsurgery. 2005; 25(4):305-9.
• [27]Judet H, Gilbert A. Long-term results of free vascularized fibular grafting forfemoral head necrosis. Clin Orthop Relat Res. 2001; 386:114-9.
• [28]Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH. Vascularized compared with non-vascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am. 2005; 87(9):2012-8.
• [29]Kawate K, Yajima H, Sugimoto K, Ono H, Ohmura T, Kobata Y, Murata K, Shigematsu K, Kawamura K, Kawahara I, Maegawa N, Tamai K, Takakura Y, Tamai S. Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. BMC Musculoskelet Disord. 2007; 8:78. BioMed Central Full Text
• [30]Lieberman JR, Conduah A, Urist MR. Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop Relat Res. 2004; 429:139-45.
• [31]Seyler TM, Marker DR, Ulrich SD, Fatscher T, Mont MA. Nonvascularized bone grafting defers joint arthroplasty in hip osteonecrosis. Clin Orthop Relat Res. 2008; 466(5):1125-32.