scholarly journals High Failure Rate after Beta-tricalcium Phosphate Grafting for the Treatment of Femoral Head Osteonecrosis: a Retrospective Analysis

2020 ◽  
Author(s):  
Pei Liu ◽  
Xiao-hong Mu ◽  
Hua-chen Yu ◽  
Guan Jian-lei ◽  
Zhao-hui Liu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Failure Rate ◽  
Tricalcium Phosphate ◽  
Bone Grafting ◽  
Harris Hip Score ◽  
Time To Failure ◽  
Light Bulb ◽  
High Failure Rate ◽  
Beta Tricalcium Phosphate ◽  
Femoral Head Osteonecrosis

Abstract Background: Non-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH). Among the various types of bone grafting techniques, “light-bulb” procedure grafting with synthetic bone substitute is an attractive option. We aimed to assess the effectiveness of using beta-tricalcium phosphate (β-TCP) for the treatment of pre-collapse and early post-collapse lesions NONFH.Methods: From April 2010 to June 2014, 33 patients (47 hips) with NONFH were treated using the afore-mentioned technique. The clinical and radiological outcomes were recorded and compared statistically between pre- and post-operation. Harris hip score (HHS) was used to evaluate the clinical results, and Association Research Circulation Osseous (ARCO) stage was applied to assess the radiological outcomes.Results: The 5-years survival rate of using β-TCP grafting was accounting for 25.5%. HHS was decreased from 78.47 to 52.87 points, and a very significant worsening of radiological results were revealed (P < 0.05). 2 hips collapsed more than 2 mm were awaiting for THA, and 33 of the 47 hips had converted to THAs in an average time to failure of 24.24 months postoperatively. Meanwhile, only 4 hips survived without collapse, and 8 hips collapsed less than 2 mm. After surgery, the time onset of head collapse was 3.65 months on average, and the first conversion to THA was performed at 5 months postoperative.Conclusions: Our results suggest that “light-bulb” procedure grafting with β-TCP sticks presented with a high failure rate in the early postoperative period. It is not proposed for the treatment of pre-collapse and early post-collapse lesions NONFH.

scholarly journals High Failure Rate after Beta-tricalcium Phosphate Grafting for the Treatment of Femoral Head Osteonecrosis: a Retrospective Analysis

2020 ◽  
Author(s):  
Pei Liu ◽  
Xiao-hong Mu ◽  
Hua-chen Yu ◽  
Guan Jian-lei ◽  
Zhao-hui Liu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Failure Rate ◽  
Tricalcium Phosphate ◽  
Bone Grafting ◽  
Harris Hip Score ◽  
Time To Failure ◽  
Light Bulb ◽  
High Failure Rate ◽  
Beta Tricalcium Phosphate ◽  
Femoral Head Osteonecrosis

Abstract Background: Non-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH). Among the various types of bone grafting techniques, “light-bulb” procedure grafting with synthetic bone substitute is an attractive option. We aimed to assess the effectiveness of using beta-tricalcium phosphate (β-TCP) for the treatment of pre-collapse and early post-collapse lesions NONFH. Methods: From April 2010 to June 2014, 33 patients (47 hips) with NONFH were treated using the afore-mentioned technique. The clinical and radiological outcomes were recorded and compared statistically between pre- and post-operation. Harris hip score (HHS) was used to evaluate the clinical results, and Association Research Circulation Osseous (ARCO) stage was applied to assess the radiological outcomes. Results: The 5-years survival rate of using β-TCP grafting was accounting for 25.5%. HHS was decreased from 78.47 to 52.87 points, and a very significant worsening of radiological results were revealed ( P < 0.05). 2 hips collapsed more than 2 mm were awaiting for THA, and 33 of the 47 hips had converted to THAs in an average time to failure of 24.24 months postoperatively. Meanwhile, only 4 hips survived without collapse, and 8 hips collapsed less than 2 mm. After surgery, the time onset of head collapse was 3.65 months on average, and the first conversion to THA was performed at 5 months postoperative. Conclusions: Our results suggest that “light-bulb” procedure grafting with β-TCP sticks presented with a high failure rate in the early postoperative period. It is not proposed for the treatment of pre-collapse and early post-collapse lesions NONFH.

scholarly journals High Failure Rate after Beta-tricalcium Phosphate Grafting for the Treatment of Femoral Head Osteonecrosis: a Retrospective Analysis

2020 ◽  
Author(s):  
Pei Liu ◽  
Xiao-hong Mu ◽  
Hua-chen Yu ◽  
Guan Jian-lei ◽  
Zhao-hui Liu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Failure Rate ◽  
Tricalcium Phosphate ◽  
Bone Grafting ◽  
Harris Hip Score ◽  
Time To Failure ◽  
Light Bulb ◽  
High Failure Rate ◽  
Beta Tricalcium Phosphate ◽  
Femoral Head Osteonecrosis

Abstract Background: Non-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH). Among the various types of bone grafting techniques, “light-bulb” procedure grafting with synthetic bone substitute is an attractive option. We aimed to assess the effectiveness of using beta-tricalcium phosphate (β-TCP) for the treatment of pre-collapse and early post-collapse lesions NONFH. Methods: From April 2010 to June 2014, 33 patients (47 hips) with NONFH were treated using the afore-mentioned technique. The clinical and radiological outcomes were compared between pre- and post-operation. Harris hip score (HHS) was used to evaluate the clinical results, and Association Research Circulation Osseous (ARCO) stage was applied to assess the radiological outcomes. Results: After 5 years’ follow-up, the failure rate of using β-TCP grafting was accounting for 74.5%. 2 hips collapsed more than 2 mm were awaiting for THA, and 33 of the 47 hips had converted to THAs in an average time to failure of 24.1±14.6 months postoperatively. Meanwhile, only 4 hips survived without collapse, and 8 hips collapsed less than 2 mm. After surgery, the time onset of head collapse was 3.6±1.4 months on average, and the first conversion to THA was performed at 5 months postoperative. Conclusions: Our results suggest that “light-bulb” procedure grafting with β-TCP sticks presented with a high failure rate in the early postoperative period. It is not proposed for the treatment of pre-collapse and early post-collapse lesions NONFH.

scholarly journals High Failure Rate after Beta-tricalcium Phosphate Grafting for the Treatment of Femoral Head Osteonecrosis: a Retrospective Analysis

2020 ◽  
Author(s):  
Pei Liu ◽  
Xiao-hong Mu ◽  
Hua-chen Yu ◽  
Guan Jian-lei ◽  
Zhao-hui Liu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Failure Rate ◽  
Tricalcium Phosphate ◽  
Bone Grafting ◽  
Harris Hip Score ◽  
Time To Failure ◽  
Light Bulb ◽  
High Failure Rate ◽  
Beta Tricalcium Phosphate ◽  
Femoral Head Osteonecrosis

Abstract Background: Non-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH). Among the various types of bone grafting techniques, “light-bulb” procedure grafting with synthetic bone substitute is an attractive option. We aimed to assess the effectiveness of using beta-tricalcium phosphate (β-TCP) for the treatment of pre-collapse and early post-collapse lesions NONFH. Methods: From April 2010 to June 2014, 33 patients (47 hips) with NONFH were treated using the afore-mentioned technique. The clinical and radiological outcomes were recorded and compared statistically between pre- and post-operation. Harris hip score (HHS) was used to evaluate the clinical results, and Association Research Circulation Osseous (ARCO) stage was applied to assess the radiological outcomes. Results: The 5-years survival rate of using β-TCP grafting was accounting for 25.5%. HHS was decreased from 78.47 to 52.87 points, and a very significant worsening of radiological results were revealed ( P < 0.05). 2 hips collapsed more than 2 mm were awaiting for THA, and 33 of the 47 hips had converted to THAs in an average time to failure of 24.24 months postoperatively. Meanwhile, only 4 hips survived without collapse, and 8 hips collapsed less than 2 mm. After surgery, the time onset of head collapse was 3.65 months on average, and the first conversion to THA was performed at 5 months postoperative. Conclusions: Our results suggest that “light-bulb” procedure grafting with β-TCP sticks presented with a high failure rate in the early postoperative period. It is not proposed for the treatment of pre-collapse and early post-collapse lesions NONFH.

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

2008 ◽  
Vol 467 (6) ◽  
pp. 1522-1528 ◽  
Author(s):  
Lih-Yuann Shih ◽  
Yon-Cheong Wong ◽  
Hsin-Nung Shih
Keyword(s):  
Femoral Head ◽  
Hip Arthroplasty ◽  
Bone Grafting ◽  
One Stage ◽  
Femoral Head Osteonecrosis

scholarly journals Management of osteonecrosis of the femoral head in children with sickle cell disease: results of conservative and operative treatments at skeletal maturity

2018 ◽  
Vol 12 (1) ◽  
pp. 47-54
Author(s):  
C. Mallet ◽  
A. Abitan ◽  
C. Vidal ◽  
L. Holvoet ◽  
K. Mazda ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Skeletal Maturity ◽  
Weight Bearing ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Cell Disease ◽  
Femoral Head Osteonecrosis

Purpose Sickle cell disease (SCD) is the most common cause of femoral head osteonecrosis (ONFH) during childhood with an overall prevalence of 10%. In children, spontaneous revascularization can occur, as in Legg-Calve-Perthes disease. Consequently, the aim of treatment is to restore proper hip containment to prevent joint arthritis. This is the first study reporting long-term results at skeletal maturity of non-operative and surgical treatments for ONFH in SCD children. Methods All children with ONFH due to SCD were retrospectively reviewed. At initial evaluation, extension of osteonecrosis was radiographically defined using Catterall, lateral pillar Herring and Ficat classifications. Subluxation of the femoral head with Reimers migration index > 30% required surgical treatment including femoral varus osteotomy and/or pelvic osteotomies. Conservative treatment including non-weight bearing and physiotherapy was performed in the remaining cases. Outcomes were assessed at skeletal maturity using the Harris Hip Score (HHS) and the Stulberg classification. Total hip arthroplasty and Stulberg 5 were defined as failures. Results A total of 25 hips in 17 patients were included (mean follow-up 7.5 years SD 3.4). Mean age at diagnosis was 11.4 years SD 2.9. In all, 15 hips (60%) were classified Catterall 3 and 4 and Herring B and C. A total of 13 patients (52%) underwent surgical treatment. At skeletal maturity, mean HHS was good (81 SD 17), 12 hips (48%) were classified Stulberg 1 and 2, seven hips (28%) were classified Stulberg 3 and 4. Conclusion Both treatments led to good functional results with 75% of congruent hips at skeletal maturity. Level of Evidence IV

scholarly journals Modified trapdoor procedures using autogenous tricortical iliac graft without preserving the broken cartilage to treat osteonecrosis of the femoral head: A Prospective Cohort Study With Historical Controls

2019 ◽  
Author(s):  
Qi Cheng ◽  
fengchao zhao ◽  
Shi-zhuang Xu ◽  
Li Zheng ◽  
Xin Zheng ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
X Rays ◽  
Clinical Failure ◽  
Light Bulb ◽  
Total Hip

Abstract Background The aim of the present study was to investigate clinical and radiological outcomes of autologous tricortical iliac graft through a window created at the femoral head, without suturing the opened articular cartilage to treat osteonecrosis of the femoral head (ONFH), called modified trapdoor procedures. Methods A total of 59 consecutive patients (67 hips ) with ONFH were included in this study, which was conducted during the period from April 2009 to March 2012. Harris hip scores (HHS) were used to evaluate hip function pre- and postoperatively. Anteroposterior and frog-position X-rays and magnetic resonance imaging (MRI) were conducted to evaluate lesion location, size, and ARCO stage. Clinical failure was defined as score < 80 points or treatment by total hip arthroplasty(THA). Radiographic failure was defined as a > 3 mm of collapse in the hip. This group was retrospectively matched according to the ARCO stage, extent, location, etiology of the lesion, average age, gender, and preoperative Harris hip score to a group of 59 patients (67 hips) who underwent the“light bulb”approach during March 2007 to April 2009. Results Mean follow-up was 91.2 ± 13.6 months (range, 75–115 months). Mean HHS was 91.3 ± 4.5, compared with 83.1± 4.5 in the “light bulb” cohort at the 6 years follow-up examination ( P < 0.001). At the 6 years follow-up, for modified trapdoor procedures, five hips (8.5%) were classified as clinical failure, and 3 hips underwent total hip arthroplasty; Seven hips were classified as (10.4%) radiographic failure.The clinical and radiographic failure of the hips treated with the modified trapdoor procedure was significantly lower than that of the hips treated with the “light bulb” procedure (p < 0.05). Survival of the joint was not significantly related to the location of the femoral head lesion between two groups, but there was better clinical and radiographic results in modified trapdoor procedures with Size-C and the ARCO stage III. Conclusion The study demonstrated superior medterm clinical results in ONFH with the use of autologous tricortical iliac block graft through a femoral head window, without suturing the opened articular cartilage.

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