gms | German Medical Science

Purpose： To investigate the curative efficacy of ONFH with hip-preserving operative technique, by grafting a vascularized bone flap harvested from iliac crest, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH.

Methods: We retrospectively reviewed 1912 patients (2179 hips) who accepted hip-preserving surgery by vascularized iliac bone grafting, because of ONFH （Ficat and Arlet stage II-IV）from January, 1985 to December,2012 in seven hospitals. The diagnosis of osteonecrosis was confirmed based on their own medical history, physical examination and imaging processing. Patients who were selected in this study had several etiologies, including alcoholic (769cases), traumatic (672 cases), glucocorticoid (459 cases) and idiopathic (279 cases). There were 1421 stage II hips, 659 stage III hips, and 99 stage IV hips, respectively. A Harris Hip Score (HHS) was obtained during follow-ups, to evaluat the hip fuctions, X-rays were taken regularly for image assessing, and the SF-36 scale was used for estimating quality of life. Terminal observation time was considered when patients had symptom-dependent indications for performing another hip-preserving surgery or THA surgery.

Results: 1912 patients (2179 hips) were eventually followed up with a median time of 12years (range from 5 years to 25years), but 278 patients lost contact. The average Harris Hip Score was 86.56±6.38 points in the last follow-up (excellent results reached 88.90 %), which were greatly improved compared to 65.60±6.72 pre-operatively. Survival analysis showed a difference in the 12-year survival rate between genders, with higher probability of conversion to THA for men (THA as an end point). Also, when compared with patients of Stages II and III cases, Stage IV cases had lower survival rate. With respect to different etiologies, higher survival in the traumatic group was found compared with other three groups after a follow-up of 5 years. The 12-years survival rates for these groups were 92.6% (traumatic), 82% (alcoholic), 89.1% (idiopathic), and 78.1% (glucocorticoid).

Conclusions: There is definite curative efficacy for the treatment of ONFH with a hip-preserving technique by vascularized iliac bone flap grafting. This technique reconstructs the biological stability of femoral head, which promotes reconstuction of necrotic areas and indirectly preserves the femoral head of patients and proves hip function. because the long-term efficacy can satisfy fundamental life requirements, especially for those young and middle-aged patients who suffer from ONFH, and it is possible for these patients to avoid or delay the need of THA surgery.