gms | German Medical Science

Objectives: To evaluate the medium-term clinical outcomes of core decompression combined implantation of a biomaterial- loaded allograft threaded cage for femoral head necrosis.

Methods: A retrospective analysis was made on the clinical data of 176 cases (211 hips) osteonecrosis of femoral head with stage I, II or IIIA according to steinberg stage who received core decompression combined implantation of a biomaterial- loaded allograft threaded cage between February 2004 to November 2010. The mean follow-up time is 7.09±1.92 years (5-9.5 years). There were 91 males(51.7%) and 85 females (48.3%)finished follow-up, with average age of 41.21±9.88 years (range,23-55 years). There were 81 left hips (46.0%), 60 right hips (34.1%) and 35 bilateral hips (19.9%). The etiology included glucocorticoid induced osteonecrosis 52cases (70hips) [29.5%], alcohol induced 79 cases (93 hips) [44.9%], trauma induced 14 cases (14 hips) [8.0%], and other causes 31 case (34 hips) [17.6%]. Pre-operative data were collected through the hospital database and review radiograph, and post-operative data were collected during follow-up visits, include Harris Hip Score(HHS) and Visual Analogue Score(VAS). A standard AP x-rays of pelvis were taken during each follow-up visit to evaluate the shape of the femoral head

Results and Conclusion: The average HHS improved from 62.8±6.6 points (58-73points) pre-operatively to 82.6±3.1 points (76-92points) at final follow-up [P<0.001]. The average VAS down from 5.15±2.0 points (2-7 points) to 1.75±1.3 points (0-4 points) [P<0.001]. There was no significant difference of HHS and VAS in patients with different etiology. Collapse was seen in 6 patients (7 hips) [3.4%] in follow-up period and another 13 cases (17 hips) [7.4%] exhibited progressive collapse. In collapse or progressive collapse cases, there were 3 glucocorticoid induced osteonecrosis, 9 alcohol induced, 1 trauma induced and 6 idiopathic osteonecrosis. The medium-term clinical efficacy of core decompression combined implantation of a biomaterial- loaded allograft threaded cage for femoral head necrosis is satisfactory, we believe this is an excellent treatment to save the femoral head which belongs to early stage of femoral head necrosis.