Long term follow-up of avascular necrosis of the femoral head in the dog

AimsThe modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE.Patients and MethodsWe performed a retrospective analysis involving 46 hips in 46 patients treated with a modified Dunn procedure for severe SCFE (slip angle > 60°) between 1999 and 2016. At nine-year-follow-up, 40 hips were available for clinical and radiological examination. Mean preoperative age was 13 years, and 14 hips (30%) presented with unstable slips. Mean preoperative slip angle was 64°. Kaplan–Meier survivorship was calculated.ResultsAt the latest follow-up, the mean Merle d’Aubigné and Postel score was 17 points (14 to 18), mean modified Harris Hip Score was 94 points (66 to 100), and mean Hip Disability and Osteoarthritis Outcome Score was 91 points (67 to 100). Postoperative slip angle was 7° (1° to 16°). One hip (2%) had progression of osteoarthritis (OA). Two hips (5%) developed AVN of the femoral head and required further surgery. Three other hips (7%) underwent implant revision due to screw breakage or change of wires. Cumulative survivorship was 86% at ten-year follow-up.ConclusionThe modified Dunn procedure for severe SCFE resulted in a low rate of AVN, low risk of progression to OA, and high functional scores at long-term follow-up. The slip deformities were mainly corrected but secondary impingement deformities can develop in some hips and may require further surgical treatment. Cite this article: Bone Joint J 2019;101-B:403–414.

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Avascular necrosis of the femoral head in long-term follow-up of systemic sclerosis: report of two cases

Clinical Rheumatology ◽

10.1007/bf02030353 ◽

1989 ◽

Vol 8 (3) ◽

pp. 386-392 ◽

Cited By ~ 9

Author(s):

E. Taccari ◽

A. Spadaro ◽

V. Riccieri ◽

M. A. Grandilli ◽

A. Zoppini

Keyword(s):

Systemic Sclerosis ◽

Femoral Head ◽

Avascular Necrosis ◽

Long Term Follow Up

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The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes’ disease

The Bone & Joint Journal ◽

10.1302/0301-620x.103b12.bjj-2021-0515.r1 ◽

2021 ◽

Vol 103-B (12) ◽

pp. 1815-1820

Author(s):

Stefan Huhnstock ◽

Ola Wiig ◽

Else Merckoll ◽

Svein Svenningsen ◽

Terje Terjesen

Keyword(s):

Femoral Head ◽

Skeletal Maturity ◽

Strong Predictor ◽

Perthes Disease ◽

Radiological Outcome ◽

Long Term Follow Up ◽

The Mean ◽

Stulberg Classification

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

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Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199505000-00004 ◽

1995 ◽

Vol 77 (5) ◽

pp. 681-694 ◽

Cited By ~ 298

Author(s):

J R Urbaniak ◽

P G Coogan ◽

E B Gunneson ◽

J A Nunley

Keyword(s):

Femoral Head ◽

Follow Up Study ◽

Long Term Follow Up ◽

Fibular Grafting ◽

Free Vascularized Fibular Grafting

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Retrospective Long-Term Follow-Up Survival Analysis of the Management of Osteonecrosis of the Femoral Head With Pedicled Vascularized Iliac Bone Graft Transfer

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.03.069 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1585-1592 ◽

Cited By ~ 2

Author(s):

Hui Xie ◽

Benjie Wang ◽

Simiao Tian ◽

Boyi Liu ◽

Kairong Qin ◽

...

Keyword(s):

Survival Analysis ◽

Femoral Head ◽

Bone Graft ◽

Iliac Bone ◽

Iliac Bone Graft ◽

Long Term Follow Up

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Free vascularized fibular graft for treatment of pathological femoral neck fracture and osteonecrosis of the femoral head: A case report with a long-term follow-up

Microsurgery ◽

10.1002/micr.20598 ◽

2008 ◽

Vol 29 (3) ◽

pp. 240-243 ◽

Cited By ~ 6

Author(s):

Alexandros E. Beris ◽

Marios G. Lykissas ◽

Alexandros Payatakes ◽

Vasileios A. Kontogeorgakos ◽

Alexandros Mavrodontidis ◽

...

Keyword(s):

Case Report ◽

Femoral Head ◽

Femoral Neck ◽

Fibular Graft ◽

Vascularized Fibular Graft ◽

Long Term Follow Up ◽

Neck Fracture ◽

Free Vascularized Fibular Graft

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Fractures and avascular necrosis before and after orthotopic liver transplantation: Long-term follow-up and predictive factors

Hepatology ◽

10.1002/hep.21805 ◽

2007 ◽

Vol 46 (4) ◽

pp. 1198-1207 ◽

Cited By ~ 72

Author(s):

Maureen M. J. Guichelaar ◽

Jeffrey Schmoll ◽

Michael Malinchoc ◽

J. Eileen Hay

Keyword(s):

Liver Transplantation ◽

Avascular Necrosis ◽

Orthotopic Liver Transplantation ◽

Predictive Factors ◽

Before And After ◽

Long Term Follow Up

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Long-term Survival and Clinical Outcomes of Non-vascularized Autologous and Allogeneic Fibular Grafts are Comparable for Treating Osteonecrosis of the Femoral Head

10.21203/rs.3.rs-101438/v1 ◽

2020 ◽

Author(s):

Ke Jie ◽

Wenjun Feng ◽

Feilong Li ◽

Keliang Wu ◽

Jinlun Chen ◽

...

Keyword(s):

Survival Rate ◽

Femoral Head ◽

Clinical Outcomes ◽

Harris Hip Score ◽

Fibular Graft ◽

Vas Score ◽

Long Term Follow Up ◽

Group A

Abstract Background Osteonecrosis of the femoral head (ONFH) is a disabling disease, which often involves young patents. Recently, various hip-preserving surgeries were recommended to delay total hip arthroplasty (THA).Questions/purposes This study aimed to compare clinical outcomes and survival rate in the long-term follow-up between core decompression combined with a non-vascularized autologous fibular graft (group A) and an allogeneic fibular graft (group B) for the treatment of ONFH.Patients and Methods We retrospectively evaluated 117 patients (153 hips) with ONFH (Association Research Circulation Osseous [ARCO] stages IIa to IIIc) who underwent the above-mentioned hip-preserving surgeries between January 2003 and June 2012. The mean (range) follow-up times (years) were 12.9 (7–16) and 9.3 (6–16) in groups A and B, respectively. Clinical outcomes were assessed using the Harris hip score (HHS), visual analog scale (VAS) score, forgotten joint score (FJS). A survival analysis was performed using the Kaplan-Meier method. The end point was THA.Results Groups A and B showed postoperative improvements, respectively, in HHS from 65±7.2 to 80.3±14.5 and from 66±5.9 to 82.4±13.6 (p<0.05), and in VAS score from 6.3±1.1 to 2.3±1.6 and from 6.1±1 to 2.2±2.2 (p<0.05). However, no significant differences in the HHS, VAS score, and hip FJS at the last follow-up (p>0.05) and 15-year survival rate (84.1% and 86%, respectively, p>0.05) were found between group A and B.Conclusions Autologous and allogeneic fibular grafts can attain equally good clinical outcomes and high survival rates in long-term follow-up, and thus can greatly delay THA owing to good bone osseointegration and sufficient mechanical support. Notably, the ratio of failure will increase when patients were more than 37 years old.Level of Evidence Level III, therapeutic study.

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