Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course

BMC Musculoskeletal Disorders

Zunhan Liu¹  Xuetao Yang¹  Yuhan Li¹  Zongke Zhou¹  Wei-Nan Zeng¹  Enze Zhao¹ 

[1] Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, 610041, Chengdu, Sichuan Province, People’s Republic of China;

关键词: Multiple drilling;    Risk factors;    Total hip arthroplasty;    Autogenous bone grafting;    Osteoarthritis;   

DOI  :  10.1186/s12891-021-04418-y

来源: Springer

【 摘 要 】

BackgroundTo determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH).MethodsWe identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling.ResultsKaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8–83.4%) and the natural course group (72.2, 95% confidence interval 64.8–79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05).ConclusionsMultiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH.Trial registrationThe trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000035180) dated 2 August 2020.

【 授权许可】

CC BY