Article
Long-term outcomes of core decompression with free vascularize fibular graft in the treatment of osteonecrosis of the femoral head: a retrospective study
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Authors
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Wei He
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Leilei Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Guoju Hong
- The University of Western Australia, Perth, Australia
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Zhinan Hong
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Zhenqiu Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Bin Fang
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Qingwen Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
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Xiaorui Han
- Guangzhou University of Chinese Medicine, Guangzhou, China
| Published: | October 23, 2017 |
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Outline
Text
Objectives: Osteonecrosis of the femoral head (ONFH) is a devastating disease with blood interruption and collapse of the femoral head. Early intervention around collapse may improve the chance of success of joint preserving procedures. The purpose of this study was to evaluate whether the core decompression with free vascularize fibular graft (CD+VF) can improve the clinical outcomes in different ARCO stages and reduce the risk of hip replacement in a long-term for average 10 years follow-up.
Methods: Between 2006 and 2010, 67 consecutive patients (77 cases) who were diagnosed with ONFH were identified from our institution's registry. 67 patients were selected to fit inclusion/exclusion criteria. All patients were treated with core decompression with free vascularize fibular graft. Functional outcomes were assessed using the Modified Harris Hip Score (MHHS), and evaluation of support system. Clinical failure was defined as deterioration of the MHHS scores and support system used severe enough to require THR. Radiologic outcome measures included the XR and MR imaging staging of the hip. Survival analysis was performed with total hip replacement as the end point failure. Collapse was defined as progression from ARCO stage I or II.
Results and Conclusion: Total seven patients were trumatic induced, 25 for steroid-induced, and 32 for alcohol-induced while 9 for idiopathic ONFH. There were 13 males (19.4%) and 54 females (80.6%) as one cases death. 1 case was in ARCO stage I, 16 in stage II, and 37 in stage III. The excellent and good rate suggested 53/66 (80.63%) of CD+VF-treated hips at a mean follow-up of 8.67±1.39 years. Failure requiring THR occurred in 12/66 (18.18%). MHHS score is 91±10. Our results illustrate that treatment CD+VF can postpone the requirment for total hip arthroplasty (THA) in patients with ONFH compared to previously reported data. Combination therapy of CD+VF may be more effective in delaying the progression of collapse in early stage ONFH. Future prospective studies are warranted to determine the efficacy of these treatment strategies in the long term.
