Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis

Floerkemeier, Thilo; Lutz, André; Nackenhorst, Udo; Thorey, Fritz; Waizy, Hazibullah; Windhagen, Henning; Lewinski, Gabriela von

doi:10.1007/s00264-010-1138-x

Cited by 57 publications

(40 citation statements)

References 23 publications

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“…The authors indicated that a porous tantalum rod was a reasonable mechanical substitute for a fibular graft. Since 2005, there have been a number of investigations of treatment of ONFH with core decompression followed by placement of a porous tantalum rod [14][15][16][17][18][19][20][21]. However, clinical outcomes, including post-operative time to weightbearing and the role of the porous tantalum implant, are conflicting [18,21].…”

Section: Introductionmentioning

confidence: 99%

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

Liu

Yan

Zhou

et al. 2015

International Orthopaedics (SICOT)

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Compared with the traditional impaction composite bone material technique, implantation of tantalum rod in the treatment of Steinberg stages I and II ONFH can obtain better clinical results and higher cumulative survival rates. For patients without the use of corticosteroids, and especially for hips without bone marrow oedema, the clinical results from our study show highly encouraging survival rates and a delay in or prevention of conversion into THA.

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Section: Introductionmentioning

confidence: 99%

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

Liu

Yan

Zhou

et al. 2015

International Orthopaedics (SICOT)

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“…They showed there was no osteogenesis repairment in the necrotic area, while various degrees of collapse were revealed in the remaining weight-bearing area. A number of articles reported definite positive efficacy of the treatment for early-stage (mainly (Association Research Circulation Osseous [ARCO] I and II) ONFH with medullary core decompression surgery [21,22]. However, a finite-elements analysis [20] of the femoral head showed that it had a harmful effect on the structural integrity of the femoral head when that surgery was used alone, and suggested it could achieve better outcomes when combined with fibular graft support [22].…”

Section: Introductionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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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 fundam...

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“…However, in other cases the femoral head could be supported by the tantalum rod for a long time. Clinical comparative analyses suggested that the tantalum rod could be used for treating ONFH, but particular attention needed to be given to its indications (Kim et al, 2010;Floerkemeier et al, 2011;Liu et al, 2012). From our experience treating ONFH with porous tantalum rods, regression analyses showed that the clinical success rate was related to the preoperative size and location of the lesion, whether or not bone grafting was used, and the SDTL.…”

Section: Discussionmentioning

confidence: 99%

Porous tantalum rods for treating osteonecrosis of the femoral head

Liu¹,

Guo²,

Li³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. This study evaluated the outcomes of using porous tantalum rods for the treatment of osteonecrosis of the femoral head (ONFH). We performed core decompression and inserted porous tantalum implants in 149 patients (168 consecutive hips) with ONFH. Hips had large (65), medium (64), or small (39) lesions; 63 lesions were lateral, 68 were central, and 35 were medial. Conversion to total hip arthroplasty (THA) was the end point of this survey. A total of 130 cases (138 hips) were followed. The mean follow-up time was 38.46 ± 5.76 months; 43 hips (31%) were converted to or needed THA. Of the 43 hips requiring THA, 33 had large lesions, including 1 medial, 3 central, and 29 lateral lesions; 9 had medium, lateral lesions, and 1 hip had a small, lateral lesion. Bone grafting was used in 59 hips, with 3 hips failing; 40 of 79 hips without bone grafts failed. The sum distances between the tops of the rods and the lateral lesion boundaries (SDTL, mm) were measured in anteroposterior and lateral radiographs. In the failure and spared groups, the average SDTLs were 7.65 ± 2.759 and 0.83 ± 2.286 mm, respectively. The survival of porous tantalum rods used for treating early-stage ONFH was affected by the size and location of the lesion, whether or not a 8343 ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 13 (4): 8342-8352 (2014) Porous tantalum rods for treating osteonecrosis bone graft was used, as well as the distance between top of the rod and the lateral boundary of the lesion.

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Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis

Cited by 57 publications

References 23 publications

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Porous tantalum rods for treating osteonecrosis of the femoral head

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