gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Treatment of Osteonecrosis of the Femoral Head with Pedicled Vascularized Iliac Bone graft Transfer: A Multicenter Study of 2190 Cases

Meeting Abstract

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  • presenting/speaker Dewei Zhao - Affiliated Zhongshan Hospital of Dalian University, Dalian, China
  • Hui Xie - Affiliated Zhongshan Hospital of Dalian University, Dalian, China
  • Dewei Zhao - Affiliated Zhongshan Hospital of Dalian University, Dalian, China

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocIN13-809

doi: 10.3205/17dkou022, urn:nbn:de:0183-17dkou0229

Published: October 23, 2017

© 2017 Zhao 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: 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: 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.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 and Conclusion: 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), respectively,Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) items ranged from 78±10 to 85±14 post-operatively against a range from 30±14 to 55±15 pre-operatively, while the postoperative mental component summary (MCS) scores (ranged from 34±11 to 59±12) significantly increased in contrast to pre-operative scores ((ranged from 72±11 to 90±10) , signifying hugely improvement of the quality of life of the patients.

Conclusions: 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.