One-stage Hip Arthroplasty and Bone Grafting for Bilateral Femoral Head Osteonecrosis

Shih, Lih‐Yuann; Wong, Yon-Cheong; Shih, Hsin-Nung

doi:10.1007/s11999-008-0393-2

Cited by 12 publications

(13 citation statements)

References 27 publications

(27 reference statements)

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“…Once femoral head collapse has occurred, the outcome is primarily correlated with the size of the collapsed segment and the degree of collapse. In the latter stages of ONFH, the extent of joint narrowing and acetabular involvement determine the prognosis and influence the type of treatment indicated [14,17,18,[22][23][24][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Are we evaluating osteonecrosis adequately?

Lee

Steinberg

2012

International Orthopaedics (SICOT)

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Purpose It is well recognised that to evaluate a patient with osteonecrosis of the femoral head (ONFH) adequately, it is necessary that the size of the infarct and the extent of femoral head joint involvement be indicated, in addition to the type or stage of the pathological process. The purpose of this study was to determine whether patients with ONFH are being evaluated adequately in studies published during the past 25 years and to see if any trends can be identified. Methods Articles describing treatment of patients with ONFH, published between 1985 and 2011, were reviewed to determine the methods used to indicate the type and extent of pathology present on radiographs and magnetic resonance imaging (MRI) studies. The classification systems cited were identified and divided between those which indicated only the stage and those which indicated both stage and extent of involvement. Results In 208 studies published between 1985 and 2011, specific classification systems were cited 237 times. During this period, non-quantitative systems, which only indicate stage, were cited 139 times (59 %) and quantitative systems, which indicate both stage and extent of involvement were cited 77 times (32 %). Between 2006 and 2011, nonquantitative systems were cited 30 times (48 %) and quantitative systems were cited 27 times (44 %). Conclusions During the past 25 years there has been a trend towards the use of more comprehensive and effective methods of evaluating patients with ONFH. However, during the past five years, approximately half of the published studies continued to use limited, non-quantitative methods of evaluation. This should be brought to the attention of the orthopaedic community. Future investigations and publications on ONFH should employ comprehensive methods of classification which include not only the stage of disease but also measurements of the size of the necrotic segment and the extent of femoral head and joint involvement.

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Section: Discussionmentioning

confidence: 99%

Are we evaluating osteonecrosis adequately?

Lee

Steinberg

2012

International Orthopaedics (SICOT)

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“…Current treatment options include weight restriction and observation, core decompression, pelvic and femoral osteotomies, bone grafting (structural or non structural and vascularised or nonvascularised), and arthroplasty (resurfacing and hemi-or total hip replacements) [4][5][6]. Conservative nonoperative treatment in adults leads to uniformly poor results.…”

Section: Discussionmentioning

confidence: 99%

“…Within many of these patients, surgical intervention is required for pain relief and better hip joint function. Surgical options include joint preserving procedures such as core decompression, osteotomy, vascularised or nonvascularised fibular grafting; and joint replacement procedures such as resurfacing and hemi-or total hip arthroplasty (THA) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Treatment of osteonecrosis of the femoral head in lymphoma patients by free vascularised fibular grafting

Yin

Zhang

Jin

et al. 2010

International Orthopaedics (SICOT)

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The purpose of this study was to assess the outcomes of treatment of femoral head osteonecrosis using free vascularised fibular grafting in patients with Hodgkin's disease and non-Hodgkin's lymphoma. We retrospectively reviewed seven patients (14 hips) with lymphoma who underwent free vascularised fibular grafting for osteonecrosis of the femoral head, evaluating pre-and postoperative Harris hip scores, visual analog scale (VAS) pain scores, hip range of motion and radiographs. Patients were followed up for a minimum of 1.5 years (mean, 3.3 years). All these patients exhibited good recovery without severe lifethreatening complications. The mean Harris hip score improved from 69 to 88, while average VAS pain score decreased from 54 to 18. At the latest follow-up, we found improvement or unchanged radiographs in all three hips with initial Steinberg stage II osteonecrosis and in nine of 11 hips with stage III or IV osteonecrosis. No hips failed treatment and underwent total hip arthroplasty. The clinical data demonstrated that free vascularised fibular grafting can slow or even halt progression of necrosis, and improve the function of the hip and quality of life in lymphoma patients.

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“…Vascularized or nonvascularized bone graft was applied to afford biomechanical support against collapse . However, this procedure is associated with donor site morbidity, failure, and other potential complications .…”

Section: Methodsmentioning

confidence: 99%

“…Vascularized or nonvascularized bone graft was applied to afford biomechanical support against collapse. (34)(35)(36)(37)(38)(39) However, this procedure is associated with donor site morbidity, failure, and other potential complications. (31) Alternatively, insertion of a porous tantalum rod has recently been developed.…”

Section: Methodsmentioning

confidence: 99%

Combination Treatment of Biomechanical Support and Targeted Intra-arterial Infusion of Peripheral Blood Stem Cells Mobilized by Granulocyte-Colony Stimulating Factor for the Osteonecrosis of the Femoral Head: A Randomized Controlled Clinical Trial

Mao

Wang

et al. 2014

Journal of Bone and Mineral Research

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Objective To determine the benefits of combination treatment with mechanical support and targeted intra-arterial infusion of peripheral blood stem cells (PBSCs) mobilized by granulocyte-colony stimulating factor (G-CSF) via the medial circumflex femoral artery on the progression of osteonecrosis of the femoral head (ONFH). Methods 55 patients (89 hips) with early and intermediate stage ONFH were recruited and randomly assigned to combination treatment or mechanical support treatment (control group). All hips received mechanical support treatment (porous tantalum rod implantation). Then, Hips in the combination treatment group were performed targeted intra-arterial infusion of PBSCs. At each follow-up, Harris hip score (HHS) and Association Research Circulation Osseous classification (ARCO) were used to evaluate the symptoms and progression of osteonecrosis. Total hip arthroplasty (THA) was assessed as an endpoint at each follow-up. Results At 36 months, 9 of the 41 hips (21.95%) in the control group progressed to clinical failure and underwent THA whereas only 3 of the 48 hips (6.25%) in the combination treatment group required THA(p=0.031). Kaplan-Meier survival analysis showed a significant difference in the survival time between the two groups (Log-rank test; p=0.025). Compared to the control group, combination treatment significantly improved the HHS at 36 months (p=0.003). At the final follow-up examination, radiological progression was noted in 13 of 41 hips (31.71%) for the control group, while only in 4 of 48 hips (8.33%) for the combination treatment group (p=0.005). The overall collapse rates were 15.15% (5 of 33 hips) and 8.11% (3 of 37 hips) in the control and combination treatment groups, respectively. Conclusions Targeted intra-arterial infusion of PBSCs is capable of enhancing the efficacy of biomechanical support in the treatment of ONFH. This clinical trial confirmed that the combination treatment might be a safe and feasible choice for the treatment of early or intermediate stages of ONFH.

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One-stage Hip Arthroplasty and Bone Grafting for Bilateral Femoral Head Osteonecrosis

Abstract: Abstract

Cited by 12 publications

References 27 publications

Are we evaluating osteonecrosis adequately?

Are we evaluating osteonecrosis adequately?

Treatment of osteonecrosis of the femoral head in lymphoma patients by free vascularised fibular grafting

Combination Treatment of Biomechanical Support and Targeted Intra-arterial Infusion of Peripheral Blood Stem Cells Mobilized by Granulocyte-Colony Stimulating Factor for the Osteonecrosis of the Femoral Head: A Randomized Controlled Clinical Trial

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