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Objective. Osteonecrosis is one of the major debilitating skeletal disorders. Most patients with osteonecrosis of the femoral head eventually need surgery, usually total hip arthroplasty (THA), within a few years of onset. Previous studies showed that alendronate has a pharmacologic effect in reducing osteoclast activity and that it significantly reduced the incidence of collapse of the femoral head in the osteonecrotic hip. The purpose of this study was to determine the cumulative incidence of THA in patients with osteonecrosis of the femoral head and the time-to-event after treatment with alendronate versus placebo during the study period. Methods.A 2-year multicenter, prospective, randomized, double-blind study was performed. From June 2005 to December 2006, 64 patients were enrolled and randomly assigned to the alendronate or placebo group. In patients with bilateral hip osteonecrosis who met the inclusion criteria, both hips were counted in the analyses. Five patients were excluded from the analysis because they did not comply with any of the study regimens. Seven patients were ineligible because they were not diagnosed as having stage IIC or stage IIIC disease according to the University of Pennsylvania system. Thus, a total of 52 patients (65 hips) were assessed in this study. Disease progression was evaluated by radiography and magnetic resonance imaging (MRI). The Harris Hip Score and the Short Form 36 health survey were used to rate hip function and quality of life, respectively.Results. There was no significant difference in radiographic and MRI data between the 2 study groups. Four of 32 hips in the alendronate treatment group underwent THA, while 5 of 33 hips in the placebo group had THA (P ‫؍‬ 0.837). No differences were noted in disease progression, Harris Hip Scores, or Short Form 36 scores between the 2 groups.Conclusion. Alendronate has no obvious effect on preventing the necessity for THA, reducing disease progression, or improving life quality.Nontraumatic osteonecrosis is frequently caused by prolonged treatment with glucocorticoids, excessive alcohol intake, systemic lupus erythematosus, or sickle cell disease, or it is idiopathic in origin. The disease is one of the most debilitating skeletal complications (1-7), yet its cause remains a subject of controversy. Each year, ClinicalTrials.gov identifier: NCT00265252.

Introduction The number of perforators required for safe perfusion remains under debate. This study aimed to determine whether a single‐ or multiple‐perforator‐based anterolateral thigh flap yields better flap outcomes in head and neck reconstruction. Patients and Methods Between August 2012 and July 2016, 180 men and 4 women with a mean age of 52.8 ± 9.8 years underwent head and neck anterolateral thigh flap reconstruction for oncologic defect in 181 cases, plate exposure in two cases, and trismus release in one case. The flap was patched for inner or external lining, folded for through–through defect, or tubed for cervical esophageal reconstruction. Of 184 flaps, 136 (73.9%) were based on multiple perforators (range, 2–5 perforators), whereas 48 (26.1%) were based on a single perforator. The demographics, operative findings, and flap outcomes were compared. Results The prevalence of systemic diseases between groups was comparable. The mean flap size in the single‐perforator group was smaller (92.8 ± 36.8 vs. 140.5 ± 99.9 cm2, P < .0001). Twenty‐one flaps (11.4%) required emergency take‐back and 13 (61.9%) were successfully salvaged. Eight flaps failed, yielding a 95.7% flap survival rate. The single‐perforator group had a significantly higher rate of emergency take‐back for vascular compromise (8/48 (16.7%) vs. 8/136 (5.9%), P = .035), a decreased salvage success rate (2/8 (25.0%) vs. 11/13 (84.6%), P = .018), and a corresponding lower flap survival rate (42/48 (87.5%) vs. 134/136 (98.5%), P = .004). Conclusion Whenever possible, we recommend including multiple cutaneous perforators in anterolateral thigh flaps to yield better flap outcomes in head and neck reconstruction.

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