Outcomes of surgical hip dislocation combined with bone graft for adolescents and younger adults with osteonecrosis of the femoral head: a case series and literature review

Abstract

Background Osteonecrosis of the femoral head (ONFH) may occur in the adolescent and younger adults (AYAs). Total hip arthroplasty (THA) is not the best treatment option for younger patients. Surgical hip dislocation (SHD) combined with bone graft can be used in patients at different stages to reconstruct the bone structure in the head and delay the replacement time. The purpose of this study was to evaluate the effect and potential influencing factors of this surgery for ONFH in AYA patients. Methods We conducted a literature review and a retrospective research of our own cases. The Pubmed, Cochrane Library, EMBASE and CNKI databases were searched from 1 January 2001 to 1 October 2021, for clinical studies. A retrospective case series study of 34 patients (38 hips) treated with SHD combined with bone graft was performed. Results A total of 13 studies were included and the results showed that SHD combined with bone grafts had better clinical results for patients with pre- or early post-collapse. In the case series study, we retrospectively analyzed 34 patients (38 hips), and the mean follow-up time was 40.77 ± 15.87 months. One patient died and three patients were converted to THA finally. The post-collapse degree and post-lesion size were better than those before the operation (P < 0.05). The iHOT-12 at the last follow-up was significantly higher than that before the operation (P < 0.05). There were significant differences in the results of hip Harris score (HHS), visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before the operation, 2 years after the operation and at the last follow-up, but the difference was not related to the follow-up time (P < 0.05). There were no significant differences in the final clinical score and arthritic changes among different Japanese Investigation Committee (JIC) classification, the degree of collapse and the size of the necrotic (P > 0.05). Conclusions In AYA patients, SHD combined with bone grafting is a potentially good option for hip preservation in ONFH. The differences in JIC classification, collapse degree and lesion size did not affect the final clinical function and the risk of osteoarthritis. Even for very severe cases at collapsed stage, good short-term clinical effects can still be achieved by SHD combined with bone graft. Trial registration ChiCTR2100055079.retrospectively registered.

Comparison of SHD-IBG and PVIBGT in ONFH including mechanical and pathological analysis of failure cases

“…However, the limited lifespan of the prosthesis and the increasingly prominent complications make it inevitable for young and middle-aged patients to face revision [16].Therefore, how to improve the success rate of hip preservation treatment is still an important issue in the development of clinical research in ONFH. [3] In 2001, Ganz et al [9] rst proposed the SHD technique, which is designed based on the fact that the main blood supply of the femoral head comes from the deep branch of the rotator medial femoral artery, and it can avoid damage to the blood ow of the femoral head [18].Later on, with the extensive use of IBG in hip preservation surgery, SHD-IBG also came into being which was used in the hip preservation treatment of ARCO stage II and III ONFH [5].…”

“…Whether the rate of hip preservation by IBG and PVIBGT is related to the progression of the patient's necrosis of the femoral head degree needs to be further studied. 5 Shortcomings and Prospects the present study, we compared the effectiveness of SHD-IBG and PVIBGT in the treatment of ARCO stage II and III femoral head necrosis at 1 year postoperatively. And through the mid-to-long-term followup of SHD-IBG for 2.5-11 (an average of 77 months) years, combined with a comprehensive analysis of patients with hip preservation failures in the two groups, it can be demonstrated that the two operation methods signi cantly improved patients' Harris scores, but were less effective in ARCO stage II and III femoral head necrosis with extensive involvement of the lateral column.…”