Core decompression or quadratus femoris muscle pedicle bone grafting for nontraumatic osteonecrosis of the femoral head: A randomized control study

Abstract

Background:The traditional management for osteonecrosis of the femoral head (ONFH) includes core decompression (CD) and quadratus femoris muscle pedicle bone graft (QF-MPBG). The aim of this study was to investigate the effects of CD and QF-MPBG on the patients with nontraumatic ONFH in an early stage.Materials and Methods:39 patients (47 hips) with ONFH in an early stage (Ficat Stage I or II) were randomly divided into two groups according to random number table method. One group was treated with CD and cancellous bone grafting. Another group was treated QF-MPBG with cancellous bone grafting. The hip function was evaluated using Harris hip score (HHS). The repair of the femoral head was estimated through X-ray, computed tomography (CT), or magnetic resonance imaging (MRI). The surgical time and intraoperative blood loss was calculated.Results:All patients were followed for an average 2.5 years (range from 1.5 to 4 years). Two hips in CD group progressed into stage 3 and three hips in QF-MPBG group processed into stage 3. No patient accepted the THA at the last followup. The HHSs significantly increased in both groups after surgery (P < 0.05). No statistical differences were found between CD and QF-MPBG groups in postoperative HHSs at last followup (P > 0.05). X-ray and CT showed that the femoral head did not progress to collapse after operation in both groups. In addition, MRI showed that the edema signals decreased. However, the surgical time was longer in QF-MPBG group than that in CD group (P < 0.05). The intraoperative blood loss was more in QF-MPBG than that in CD group (P < 0.05).Conclusion:The CD with bone graft could relieve hip pain, improve hip function with much lesser surgical trauma compared to QF-MPBG. Hence, the CD with bone graft should be generally used for the treatment of patients with an early stage (Ficat Stage I or II) ONFH.

Efficacy of various core decompression techniques versus non-operative treatment for osteonecrosis of the femoral head: a systemic review and network meta-analysis of randomized controlled trials

“…Figure 3 .C depicted the network plot of the various JPT methods comparing the rate of radiographic progression results. Seven interventions (CD, CD + BG, CD + TI, CD + CT, CD + BG + CT,VBG, and non-surgical treatment) were compared in 15 studies [ 15 , 17 , 32 – 36 , 38 , 39 , 41 – 44 , 46 , 47 ] and pooled results. CD and CD + CT were compared directly more than the other treatment.…”

Bayesian Network Meta-Analysis of the Effectiveness of Various Interventions for Nontraumatic Osteonecrosis of the Femoral Head

“…There were many studies that investigated the efficacy of CD for the treatment of patients with early-stage ONFH. Nevertheless, the clinical success of CD has inconsistencies (from 47% to 83%), mainly related to many different factors including causes and the stage of the lesion, skill of procedures, and duration of follow-up [ 20 – 23 ]. Based on our network results and rankings results, CD provided a moderate outcome in terms of improving HHS and preventing treatment failures as compared with other joint-preserving treatments.…”

Emerging roles of MicroRNAs in osteonecrosis of the femoral head

“…6,7 While the former occurs following physical trauma, the aetiology of non-traumatic ONFH is complicated and multifactorial. 8,9 Alcohol addiction, preexisting abnormal circulating function and glucocorticoid treatment all increase the risk of non-traumatic ONFH.…”