gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Long term follow-up of phemister bone grafting for patients with non-traumatic osteonecrosis of femoral head

Meeting Abstract

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  • presenting/speaker Cheng-Ta Wu - Dep. of Orthopaedic Surgery, Chang Gung Memorial Hospital , Kaohsiung, Taiwan
  • Mel S Lee - Dep. of Orthopaedic Surgery, Chang Gung Memorial Hospital , Kaohsiung, Taiwan
  • Po-Chun Lin - Dep. of Orthopaedic Surgery, Chang Gung Memorial Hospital , Kaohsiung, Taiwan
  • Shih-Hsiang Yen - Dep. of Orthopaedic Surgery, Chang Gung Memorial Hospital , Kaohsiung, Taiwan
  • Jun-Wen Wang - Dep. of Orthopaedic Surgery, Chang Gung Memorial Hospital , Kaohsiung, Taiwan

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO30-311

doi: 10.3205/17dkou895, urn:nbn:de:0183-17dkou8956

Published: October 23, 2017

© 2017 Wu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives: Osteonecrosis of the femoral head (ONFH) is debilitating disease that affects the hips of young adults. Total hip arthroplasty (THA) is often required if effective treatment methods are not adopted in the early stage to defer disease progression. Clinical and experimental studies by Phemister and Bonfiglio on the treatment of ONFH have described the technique of core decompression and insertion of two strut bone grafts as an efficacious measurement for early-stage ONFH. The purpose of this study was to investigate the survivorship and risk factors for radiographic progression and conversion to THA after Phemister procedure.

Methods: From 1994 to 2010, we treated 31 hips in 26 patients with pre-collapsed or early-collapsed (< 2mm) ONFH by Phemister procedure (core decompression and insertion of 2 strut fibular allografts). A total of 29 hips were available for evaluation of which 9 were ARCO stage IIA, 13 stage IIB, 4 stage IIC, and 3 stage IIIA. The patients were 24~58 years of age (mean, 38.9 years). The mean follow-up was 13 years. Demographic data, Harris hip score (HHS), and radiographic parameters were reviewed. Survivorship was analyzed with conversion to THA as the endpoint.

Results and Conclusion: ResultsA total of 10 hips underwent THA at a mean of 10 years (SD 6.1). The overall clinical successful rate for hip preserving was 65.5%, and radiological successful rate without further collapse or progression was 31% after a mean follow-up of 13 years. The mean HHS improved from 50.3 (SD 7.8) to 76.1 (SD 13.3). The survival time of hips analyzed by Kaplan-Meier curves was significantly shorter with male patients (P < 0.01), ARCO stage III disease (P = 0.03), a lateral lesion (P < 0.01), and a necrotic index equal or more than 0.6 (P < 0.01). The Cox proportional hazards model showed that gender, ARCO stage and necrotic index were independent risk factors for conversion to THA, while age and the location of lesion were independent risk factors for radiological progression.

Conclusions Phemister procedure is technically simpler and more appealing than vascularized fibular bone graft. It provides decompression of the lesion and support of the subchondral bone. In our study, this technique has shown acceptable long-term outcomes without serious complications, especially for lesions with earlier stage and smaller necrotic index. As a head-preserving procedure, Phemister technique is worthwhile for young patients to postpone the need for THA.