Long-term outcomes of transtrochanteric rotational osteotomy for non-traumatic osteonecrosis of the femoral head

Morita, Daigo; Hasegawa, Yukiharu; Okura, Toshiaki; Osawa, Yusuke; Ishiguro, Naoki

doi:10.1302/0301-620x.99b2.bjj-2016-0417.r2

Cited by 42 publications

(28 citation statements)

References 32 publications

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“…At present time, there are various methods for the treatment of early-stage ONFH, such as extracorporeal high-energy shock wave therapy [17], core decompression [32], tantalum rod implantation [7], silk protein rod implantation [5], bone grafting [18], and rotational osteotomy [33]. Reconstruction of mechanical support of the femoral head is the key to the treatment of ONFH.…”

Section: Discussionmentioning

confidence: 99%

The effect of the necrotic area on the biomechanics of the femoral head - a finite element study

Wen

Hao

Yue

et al. 2020

BMC Musculoskelet Disord

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Background: Femoral head collapse is the key to the progress of osteonecrosis of the femoral head (ONFH), but the causes of collapse are not completely clear. The better understanding of the progress of femoral head collapse will guide the treatment strategy for ONFH patients. The purpose of this study was to evaluate the biomechanical influence of necrosis area on the collapse of the femoral head by finite element analysis. Methods: CT and MRI data from the hip joint of a healthy volunteer were collected to establish a finite element (FE) model of a normal hip. Subsequently, five categories of osteonecrosis FE models were established by using the normal model and computer software according to China-Japan Friendship Hospital (CJFH) classification for ONFH. The CJFH system includes five types based on the size and location of necrosis lesions in the femoral head (type M, C, L1, L2, and L3) and the stage of ONFH. The collapse indices of each model were analyzed by FE method, including the displacement, peak von Mises stress and stress index of the simulated necrotic area as well as the lateral pillar contact area of the femoral head to acetabular. Results: (1) The displacement increments in the simulated necrotic areas of type M, C, L1, L2, and L3 models were 3.75 μm, 8.24 μm, 8.47 μm, 18.42 μm, and 20.44 μm respectively; the peak von Mises stress decrements were 1.50 MPa, 3.74 MPa, 3.73 MPa, 4.91 MPa, and 4.92 MPa respectively; and the stress indices were 0.04, 0.08, 0.08, 0.27, and 0.27 respectively. (2) The displacement increments in the lateral pillar contact areas of five type models were significantly different (P < 0.001) and increased in sequence as follows: 1.93 ± 0.15 μm, 5.74 ± 0.92 μm, 5.84 ± 1.42 μm, 14.50 ± 3.00 μm, and 16.43 ± 3.05 μm. The peak von Mises stress decrements were also significantly different (P < 0.001) and increased in sequence as follows: 0.52 ± 0.30 MPa, 0.55 ± 0.12 MPa, 0.67 ± 0.33 MPa, 4.17 ± 0.59 MPa, and 4.19 ± 0.60 MPa. (3) The collapse indices including the displacement increments and peak von Mises stress decrements of type L2 and L3 models were markedly higher than those of type M, C, and L1 models (P < 0.001). Conclusions: The collapse indices of the femoral heads of type L2 and L3 FE models were significantly higher than those of type M, C, and L1. Different areas of necrosis result in varied impact on the femoral head collapse.

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Section: Discussionmentioning

confidence: 99%

The effect of the necrotic area on the biomechanics of the femoral head - a finite element study

Wen

Hao

Yue

et al. 2020

BMC Musculoskelet Disord

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“…ONFHN is commonly diagnosed in patients aged 40 years or younger and may be linked to steroid or alcohol use, trauma [1,5,11e14]. There are a variety of hip-sparing management strategies for these patients including core decompression [15,16], nonvascularized bone grafts [17,18], free vascularized fibular grafts [1,5,11e13,19e21], stem cell injection [22], peritrochanteric osteotomies [23], electrical stimulation [24,25], and activity modification [14]. Regardless of the treatment, patients remain at a risk of further progression of disease and may ultimately require THA.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

Ryan

Wooster

Jiranek

et al. 2019

The Journal of Arthroplasty

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Keywords:osteonecrosis avascular necrosis free vascularized fibular graft total hip arthroplasty conversion arthroplasty a b s t r a c t Background: Conversion total hip arthroplasties (THAs) from prior free vascularized fibular grafting (FVFG) are infrequently reported in the literature. We characterized the perioperative outcomes of patients undergoing conversion THA and compared them with those of a matched cohort of patients undergoing primary THA for osteonecrosis of the femoral head and neck (ONFHN). Methods: The institutional database was queried for patients with FVFG requiring conversion to THA. This cohort was then matched 1:1 for age, gender, and American Society of Anesthesiologists (ASA) score for patients with ONFHN undergoing primary THA. Medical records were reviewed for intraoperative and postoperative complications, which were then compared between conversion and primary THA patient cohorts. Results: Two hundred eighty-eight THA patients were included for analysis (144 patients with FVFG matched to 144 patients with ONFHN and no prior FVFG). Patients with prior FVFG who underwent THA had significantly greater operative time and blood loss (P < .001). Although not significant, there were more intraoperative fractures in the FVFG cohort (P ¼ .053). Postoperatively, patients with FVFG had significantly greater blood transfusions (P < .001) and hematoma formation (P ¼ .004) than the matched cohort. There was no difference in length of stay, discharge disposition, or venous thromboembolism; however, patients who underwent conversion THA showed increased deep infection (P ¼ .044) and rate of return to the operating room (P ¼ .010). Conclusion: Although there are numerous treatment strategies for patients with ONFHN, many patients will ultimately require THA. Patients undergoing conversion after FVFG are more likely to have complications including increased blood loss, hematoma formation, and intraoperative fractures. Consequently, surgeons should concentrate on preoperative optimization and prepare for specific technical challenges.

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“…Currently, hip-preserving surgeries for ONFH mainly included core-decompression [9,10], vascularized or non-vascularized bone grafting [1,6,11,12], and osteotomy of the femur or acetabulum [13][14][15]. Hip-preserving surgery with vascularized pedicle iliac bone grafting (VPIBG) is an effective treatment for ONFH, which can reduce the intraosseous pressure, promote the revascularization of ischemic areas, provide structural support to prevent collapse [5,[16][17][18], and can be easily implemented without microsurgery techniques.…”

Section: Introductionmentioning

confidence: 99%

How long does a hip-preserving surgery with vascularized pedicle iliac bone grafts for femur head necrosis last? A systematic review and meta-analysis of case series with an average more than 5-year follow-up

Zhu

Zhang

Sun

et al. 2020

Preprint

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Background: Hip-preserving surgeries with vascularized pedicle iliac bone grafts (VPIBG) are effective for osteonecrosis of the femoral head (ONFH). However, few studies exist about the long-term efficacy of this procedure. The aim of this meta analysis was to investigate how long does this hip-preserving surgery last. Methods: A comprehensive search was carried out through PubMed, Embase and Cochrane Collaboration Library for all relevant studies up to November 2019. The literature search strategy contained Medical Subject Headings and terms relating to ONFH and bone transplantation. All included studies were articles on VBIPG for ONFH, with an average follow-up of more than 5 years. Interesting outcomes included clinical success rates, complications, and conversion rates of THA. The data from eligible studies were then extracted and synthesized. The pooled effect size (ES) and 95% confidence intervals (CIs) were calculated. Results: Ten studies were finally selected. Eight studies including 3413 hips were pooled into the meta-analysis of success rates, the overall ES was 0.89 (95% CI, 0.86–0.92). In subgroup analysis, the ES was 0.88 (95% CI, 0.78–0.98) and 0.90 (95% CI, 0.87–0.92) at an average 5-10 years and 10-15 years follow-up, respectively. Pooled analysis of THA conversion rates derived from 7 studies (3389 hips) showed the overall ES of 0.10 (95% CI, 0.09–0.11). Seven studies (3396 hips) were included in a meta-analysis of complication rates, and the overall ES was 0.12 (95% CI, 0.08–0.18). The most common complications were secondary wound healing (37.6%), numbness or paresthesia of the lateral thigh (22.4%), and deep vein thrombosis (19.6%). Conclusions: The hip-preserving surgery with VPIBG is a safe and effective treatment for early-stage ONFH, but it should be used with caution in the treatment of advanced femoral head necrosis. The pooled data from this study suggested that 90% of the hips in patients with ONFH lasted 10 years after this surgery. However, most of the included studies are case series, and these conclusions will need the support of high-quality research in the future.

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Long-term outcomes of transtrochanteric rotational osteotomy for non-traumatic osteonecrosis of the femoral head

Abstract: The 15 year outcomes after TRO for ONFH are unfavorable because osteoarthritic changes occur after five years post-operatively. Cite this article: Bone Joint J 2017;99-B:175-83.

Cited by 42 publications

References 32 publications

The effect of the necrotic area on the biomechanics of the femoral head - a finite element study

The effect of the necrotic area on the biomechanics of the femoral head - a finite element study

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting

How long does a hip-preserving surgery with vascularized pedicle iliac bone grafts for femur head necrosis last? A systematic review and meta-analysis of case series with an average more than 5-year follow-up

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