Evaluation of bipolar hemiarthroplasty for the treatment of steroid-induced osteonecrosis of the femoral head
ABSTRACT Bipolar hemiarthroplasty (BHA) for idiopathic osteonecrosis of the femoral head (ONFH) is performed at our institution. The purpose of this study was to evaluate the clinical and radiographic findings after BHA for the treatment of steroid -induced ONFH.
Thirty-seven hips in 27 patients were assessed (seven men, 11 hips; 20 women, 26 hips), average patient age at the time of surgery of 42.6 (range 20-83) years, with steroid-induced ONFH treated with BHA between 1995 and 2005. The mean follow-up duration was approximately ten (range five to15) years. Patients were evaluated according to the Japan Orthopaedic Association (JOA) hip score. Kaplan-Meier survivorship was calculated to examine revision arthroplasty failure rate. Radiographic analysis of loosening included radiolucent lines and osteolysis of the acetabulum or femur. Causes of loosening were analysed using multiple logistic regression.
JOA hip score increased from 53 points (preoperative) to 87 points (final follow-up). Survival rates were 96.8 % and 78.6 % at ten and 15 years, respectively. Prosthesis loosening occurred on the acetabular side in five hips (13.5 %). No femoral-component loosening was observed. BHA had poor results in patients with Association Research Circulation Osseous (ARCO) stage IV ONFH and in patients under 40 years of age.
BHA, with strict surgical indications, may be a good option for treating ONFH. Based on these results, total hip arthroplasty is recommended for patients with ARCO stage IV ONFH or for patients under 40 years of age.
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ABSTRACT: PURPOSE: To investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by grafting a vascularized greater trochanter flap combined with a free iliac flap, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH without total hip arthroplasty (THA) surgery. METHOD: Our research included a total of 60 patients (66 hips) who accepted hip-preserving surgery by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering because of ONFH (most were Association Research Circulation Osseous (ARCO) stage III patients) from January, 2006 to December, 2010. A Harris Hip Score was obtained during follow-ups, evaluating the clinical efficacy, 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-dependant indications for performing another hip-preserving surgery or THA surgery. RESULTS: Fifty-eight patients (64 hips) were eventually contacted by telephone for an out-patient clinic return visit, with a mean follow-up time of 35.8 months (varied from 12 months to 60 months), but two patients lost contact for various reasons. The demographic data were as follows: there were 16 ARCO IIIA cases, 22 ARCO IIIB cases, and 26 ARCO IIIC cases, respectively. Postoperative X-rays revealed a well-repaired necrotic area of the femoral head and improvement of femoral-acetabulum coverage. The last follow-up mean Harris Hip Score was 86.56 ± 7.38 (excellent results reached 87.50 %), which were greatly improved compared to 50.95 ± 6.86 pre-operatively. Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) scores were enhanced from 42 ± 13 pre-operatively to 78 ± 11, while the postoperative mental component summary (MCS) scores (76 ± 11) largely increased in contrast to pre-operative scores (51 ± 10), with both target indices having statistical significance (p = 0.005, p = 0.01), signifying hugely improvement of the quality of life of the patients. A correlation was found between Harris Hip Score and all dimensions of SF-36 scale (r = 0.32-0.72), especially closely correlated with physical functioning (PF), role-physical (RP) and bodily pain (BP) in PCS aspect (r = 0.72, p < 0.01; r = 0.58, p < 0.01; r = 0.65, p < 0.01, respectively). CONCLUSION: There is definite curative efficacy for the treatment of ONFH with an hip-preserving operative approach by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering. This kind of operative approach reconstructs the biological stability of femoral head, which promotes repair of necrotic areas and indirectly preserves the femoral head of patients and a majority of hip function. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundamental life requirements, especially for those young and middle-aged patients who suffer ONFH to avoid or put off the time of total hip arthroplasty(THA) surgery.International Orthopaedics 01/2013; 37(3). DOI:10.1007/s00264-012-1773-5 · 2.02 Impact Factor
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ABSTRACT: PURPOSE: Avascular necrosis (AVN) of the femoral head is a common orthopaedic disease that is difficult to treat. The purpose of this study was to explore the preliminary efficacy of a self-designed umbrella-shaped memory alloy femoral head support device in the treatment of adult patients with avascular osteonecrosis of the femoral head. METHODS: The minimally-invasive approach involved curettage of the necrotic tissue of the femoral head, and a self-designed umbrella-shaped, memory alloy femoral head support device was implanted into the collapsed necrotic area to support the collapsed femoral head. Autologous iliac bone and artificial bone were implanted into the support device for the treatment of adult patients with avascular osteonecrosis of the femoral head. RESULTS: The clinical device was used in ten patients and 18 hip joints. The support device failed in one hip joint, which subsequently underwent joint replacement surgery, and the remaining 17 implanted devices were followed up for four to 19 months. The 17 postoperative hip joints were evaluated using the percent-efficacy evaluation method for avascular osteonecrosis of the femoral head in adult patients, and the efficacy rate was 82.35 %. CONCLUSION: The umbrella-shaped femoral head support device can be used in Ficat stage I, stage II, and stage III adult patients with avascular osteonecrosis of the femoral head.International Orthopaedics 03/2013; 37(7). DOI:10.1007/s00264-013-1869-6 · 2.02 Impact Factor
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ABSTRACT: Purpose The purpose of this study was to evaluate clinical and radiological outcomes of autologous osteochondral transfer (OATS) for femoral head osteonecrosis. Methods Twenty-one hips in 20 patients (one woman and 19 men), average patients' age at the time of surgery of 35.4 (range 20–56) years, were treated with OATS for osteonecrosis of the femoral head (ONFH). Seven patients at pre-collapse ARCO stages IIA and IIB were treated with OATS alone. Thirteen patients with large pre-collapse ARCO IIC and post-collapse ARCO III and IV were treated with OATS and morselised bone allografts (OATS/allograft). Harris hip score (HHS) was used for clinical evaluation of outcomes; X-rays were performed to examine the evolution of the disease. Kaplan-Meier survival curves were used to determine the failure of the procedures with conversion to THR defined as endpoint. Results Follow-up of patients treated with OATS alone was 46.14 (range 18–75) months with HHS improvement from a preoperative mean of 42 to 87.85 points at the latest follow-up examination. Only one patient in this group needed a revision operation with THR. The survival for this group of patients was 85.71 % at four years. Follow-up of patients treated with AOTS/allograft was 32.7 (range 7–84) months with HHS improvement from a preoperative mean of 35.2 to 65.7 points at the latest follow-up examination. One patient died six months after the surgery. There were five conversions to THR because of femoral head collapse in this group of patients with survival of 61.54 % at three years. Conclusion The use of osteochondral grafts offers the possibility of successful treatment for ONFH at small and medium pre-collapse stages. The outcomes of large pre-collapse and post-collapse stages were below our expectations. OATS is a time buying procedure for young patients as it may defer total hip replacement.International Orthopaedics 05/2013; 37(7). DOI:10.1007/s00264-013-1893-6 · 2.02 Impact Factor