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

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.

scholarly journals Long-term survival and clinical outcomes of non-vascularized autologous and allogeneic fibular grafts are comparable for treating osteonecrosis of the femoral head

2021 ◽  
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.

scholarly journals Long-term survival and clinical outcomes of non-vascularized autologous and allogeneic fibular grafts are comparable for treating osteonecrosis of the femoral head

2021 ◽  
Vol 16 (1) ◽  
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 ◽  
Term Survival ◽  
Vas Score ◽  
Long Term Follow Up

Abstract Background Osteonecrosis of the femoral head (ONFH) is a disabling disease, which often involves young patients. 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 abovementioned 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, and 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 groups 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

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 ◽  
2008 ◽  
Vol 29 (3) ◽  
pp. 240-243 ◽  
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

scholarly journals A Mid- to Long-Term Results of The Avascular Fibular Grafting in ONFH With 6 to 8-Year Follow-Up

2020 ◽  
Author(s):  
Peng Yuan ◽  
Bin Du ◽  
Xin Liu ◽  
Guang-Quan Sun ◽  
Xuan-Ye Lin ◽  
...  
Keyword(s):  
Survival Rate ◽  
Femoral Head ◽  
Clinical Success Rate ◽  
Activity Level ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Small Scale ◽  
Fibular Grafting

Abstract Background: Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. Nevertheless, this operation is traumatic and expensive. This study analyzed the long-term outcomes of avascular fibular grafting for osteonecrosis of the femoral head(ONFH) with 6 to 8 year follow-up.Methods: From March 2009 to March 2012, 34 patients(48 hips) were diagnosed the ONFH with Association Research Circulation Osseous(ARCO) stage of Ⅱ to Ⅲb and operated with avascular fibular grafting in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic effects of these patients and assessed the difference effects with diverse stages(ARCO) and types(China-Japan Friendship Hospital classification, CJFH) annually. The hip survival rate, Harris hip score, activity level and imaging stability were calculated. The average follow-up time was 6.7 years.Results: At the last follow-up,34 of 48 hips survived totally. Depending on the ARCO stage, The overall clinical success rate for hip preserving were 76.0% (19/25) in Ⅱ stage ,85.7%(12/14) in ⅢA stage and 33.3%(3/9) in ⅢB stage. Referring to the CJFH classification system, the hip survival rate were 100%(2/2) in M type,90.9%(10/11) in C type,77.8%(14/18) in L1 type,57.1%(8/14) in L2 type and 0%(0/3) in L3 type. The mean VAS score, HHS, and WOMAC were significantly improved at the final follow-up compared with preoperative values (p < 0.001).Conclusion: The avascular fibular grafting operation can increase the hip function and improve patients’ lives quality. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty(THA) surgery.

scholarly journals Mid- to long-term results of modified avascular fibular grafting for ONFH

2021 ◽  
Author(s):  
Peng Yuan ◽  
Xin Liu ◽  
Bin Du ◽  
Guang-Quan Sun ◽  
Xu Wang ◽  
...  
Keyword(s):  
Survival Rate ◽  
Femoral Head ◽  
Clinical Success Rate ◽  
Activity Level ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Small Scale ◽  
Fibular Grafting

Abstract Free vascularized fibular grafting was reported a favorable method to prevent the collapse of the femoral head. This study analyzed the mid- to long-term outcomes of avascular fibular grafting (AVFG) for osteonecrosis of the femoral head (ONFH) with 6- to 8-year follow-up. From March 2009 to March 2012, 34 patients (48 hips) were diagnosed with ONFH operated with AVFG in Jiangsu Province Hospital of traditional Chinese Medicine. We retrospectively reviewed the clinic outcomes of these patients and evaluated the differences in outcomes by diverse stages [Association Research Circulation Osseous (ARCO)] and types [China–Japan Friendship Hospital (CJFH) classification] annually. The hip survival rate, Harris hip score (HHS), activity level and imaging stability were calculated. The average follow-up time was 6.7 years. At the last follow-up, 34 of 48 hips survived totally. According to the ARCO stage, the overall clinical success rate for hip preserving were 76.0% (19/25) in II stage, 85.7% (12/14) in IIIA stage and 33.3% (3/9) in IIIB stage. Referring to the CJFH classification system, the hip survival rate were 100% (2/2) in M type, 90.9% (10/11) in C type, 77.8% (14/18) in L1 type, 57.1% (8/14) in L2 type and 0% (0/3) in L3 type. The mean visual analog scale (VAS) score, HHS and Western Ontario McMaster Osteoarthritis index (WOMAC) were significantly improved at the final follow-up compared with pre-operative values (P &lt; 0.001). The AVFG operation can increase the hip function and improve patients’ lives quality. The mid- to long-term efficacy can satisfy fundamental life requirements, especially for those early-stage and small-scale patients who suffer ONFH to avoid or put off the time of total hip arthroplasty surgery.

Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up

2019 ◽  
Vol 101-B (4) ◽  
pp. 403-414 ◽  
Author(s):  
T. D. Lerch ◽  
S. Vuilleumier ◽  
F. Schmaranzer ◽  
K. Ziebarth ◽  
S. D. Steppacher ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Slipped Capital Femoral Epiphysis ◽  
Harris Hip Score ◽  
Slip Angle ◽  
Functional Scores ◽  
Screw Breakage ◽  
Long Term Follow Up

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.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

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

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.

scholarly journals Balloon-expandable stents for treatment of symptomatic middle cerebral artery stenosis: Clinical outcomes during long-term follow-up

2018 ◽  
Vol 24 (6) ◽  
pp. 666-673 ◽  
Author(s):  
Sung Hyun Baik ◽  
Hyo Sung Kwak ◽  
Gyung Ho Chung ◽  
Seung Bae Hwang
Keyword(s):  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Reperfusion Therapy ◽  
Stent Insertion ◽  
Recurrence Rates ◽  
Long Term Follow Up ◽  
Ischemic Events

Background Insertion of a balloon-expandable stent (BES) in patients with symptomatic intracranial atherosclerosis is a treatment option for reperfusion therapy. In this study, we retrospectively reviewed clinical outcomes during long-term follow-up after insertion of balloon-expandable stents in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods Institutional review board approval was obtained for retrospective review of patient data. Thirty-four patients (15 men, 19 women; median age, 67.5 years) with symptomatic MCA stenosis underwent balloon-expandable stent insertion between June 2008 and December 2010. Patient records were reviewed for angiographic findings and clinical outcomes during long-term follow-up. Results Of these patients, 22 presented with acute ischemic stroke with underlying MCA atherosclerosis and had good clinical outcomes (modified Rankin Scale score (mRS): 0–2) after reperfusion therapy. Indications for stenting for the remaining 12 patients were recurrent transient ischemic attacks (TIAs) refractory to medical therapy and MCA stenosis greater than 70%. During the poststenting follow-up period, which ranged from 61 to 108 months (median, 67.5 months), a TIA occurred in five patients. Of these five patients, one experienced a complete reocclusion of the MCA stent, and three had symptomatic restenosis. The remaining 29 patients did not experience any further ischemic events or restenosis during the follow-up period. Conclusions In our study, treatment with balloon-expandable stents in patients with symptomatic MCA stenosis resulted in low recurrence rates for both ischemic events and restenosis during long-term follow-up.

scholarly journals Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

2021 ◽  
Vol 2 (12) ◽  
pp. 1035-1042
Author(s):  
Maciej Okowinski ◽  
Mette Holm Hjorth ◽  
Sebastian Breddam Mosegaard ◽  
Jonathan Hugo Jürgens-Lahnstein ◽  
Stig Storgaard Jakobsen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Femoral Bone ◽  
Total Hip ◽  
Stem Subsidence ◽  
Femur Fractures

Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.

Sign in / Sign up

Export Citation Format

Share Document