Nomogram to predict collapse-free survival after core decompression of nontraumatic osteonecrosis of the femoral head

Journal of Orthopaedic Surgery and Research

Zun-Han Liu¹  En-Ze Zhao¹  Zhen-Yu Luo¹  Zong-Ke Zhou¹  Zi-Chuan Ding¹  Wei-Nan Zeng² 

[1] Department of Orthopedics, Orthopedic Research Institute, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People’s Republic of China;Department of Orthopedics, Orthopedic Research Institute, West China Hospital/West China School of Medicine, Sichuan University, 37# Wuhou Guoxue Road, Chengdu, People’s Republic of China;Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Sciences, 400014, Chongqing, China;

关键词: Core decompression;    Risk factors;    Nomogram;    Total hip arthroplasty;   

DOI  :  10.1186/s13018-021-02664-3

来源: Springer

【 摘 要 】

BackgroundNontraumatic osteonecrosis of the femoral head (NONFH) is a devastating disease, and the risk factors associated with progression into collapse after core decompression (CD) remain poorly defined. Therefore, we aim to define risk factors associated with collapse-free survival (CFS) after CD of precollapse NONFH and to propose a nomogram for individual risk prediction.MethodsAccording to the baseline characteristics, clinical information, radiographic evaluations, and laboratory examination, a nomogram was developed using a single institutional cohort of patients who received multiple drilling for precollapse NONFH between January 2007 and December 2019 to predict CFS after CD of precollapse NONFH. Furthermore, we used C statistics, calibration plot, and Kaplan-Meier curve to test the discriminative ability and calibration of the nomogram to predict CFS.ResultsOne hundred and seventy-three patients who underwent CD for precollapse NONFH were retrospectively screened and included in the present study. Using a multiple Cox regression to identify relevant risk factors, the following risk factors were incorporated in the prediction of CFS: acute onset of symptom (HR, 2.78; 95% CI, 1.03–7.48; P = 0.043), necrotic location of Japanese Investigation Committee (JIC) C1 and C2 (HR, 3.67; 95% CI, 1.20–11.27; P = 0.023), necrotic angle in the range of 250–299°(HR, 5.08; 95% CI, 1.73–14.93; P = 0.003) and > 299° (HR, 9.96; 95% CI, 3.23–30.70; P < 0.001), and bone marrow edema (BME) before CD (HR, 2.03; 95% CI, 1.02-4.02; P = 0.042). The C statistics was 0.82 for CFS which revealed good discriminative ability and calibration of the nomogram.ConclusionsIndependent predictors of progression into collapse after CD for precollapse NONFH were identified to develop a nomogram predicting CFS. In addition, the nomogram could divide precollapse NONFH patients into prognosis groups and performed well in internal validation.

【 授权许可】

CC BY