Dewei Zhao1, Hui Xie1, Yongqing Xu2, Yisheng Wang3, Aixi Yu4, Youwen Liu5, Aimin Wang6, Wei He7, Xiuli Wang3, Zirong Li8, Wei Sun8, Simiao Tian1, Benjie Wang1, Baoyi Liu1. 1. Orthopedic Department, Affiliated Zhongshan Hospital of Dalian University, No 6 Jiefang Street, Zhongshan District, Dalian, China. 2. Orthopedic Department, Kunming General Hospital of the Chengdu Military Area Command, Yunnan Province, China. 3. Orthopedic Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Shi, Henan Sheng, China. 4. Orthopedic Department, Zhongnan Hospital of Wuhan University, Wuchang Qu, Wuhan Shi, Hubei Sheng, China. 5. Orthopedic Department, Henan Sheng Luoyangzhengguyiyuan, China. 6. Orthopedic Department, Daping Hospital, Research Institute of Surgery, Third Military Medical University, Chongqing, China. 7. Orthopedic Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China. 8. Orthopedic Department, China-Japan Friendship Hospital, Chaoyang Qu, Beijing Shi, China.
Abstract
BACKGROUND: Osteonecrosis of the femoral head (ONFH) often affects young active adults and leads to destruction of the hip joint and disabling arthritis. Several procedures have been developed to arrest the progress of osteonecrosis and postpone the procedure of total hip replacement especially in young patients. The aim of this multicenter study was to analyze the results of the use of the vascularized iliac bone flap transfer for management of ONFH. METHODS: From January 1985 to December 2012, a total of 2190 patients (2690 hips) with the mean age of 43.15 years (ranging from 18 to 65 years) underwent hip-preserving surgery with the pedilced iliac bone flap transfer for management of ONFH with Ficat and Arlet stage II-IV in 8 hospitals. There were 1733 hips in stage II, 776 hips in stage III, and 181 hips in stage IV preoperatively. The complications were recorded. The outcomes were evaluated by radiograph, the Harris hip-scoring system (HHS). RESULTS: Postoperative complications occurred in 128 patients (5.84%). Among them, 25 patients had deep venous thromboses, 16 patients had sensory deficits, 40 patients had superficial infection and hematoma, and 47 patients had wound dehiscence. A total of 1912 patients (2179 hips) were followed up with a median time of 12 years (ranging from 5 to 25 years). There were 1787 hips with no radiographic osteonecrotic progress during follow-up, while osteonecrosis progress was observed in 186 hips with stage II (13.1%), 170 hips with stage III (25.6%) and 36 hips with stage IV (36.4%; P < .001). Two hundred fifteen hips (9.87%) in 203 patients were converted to THA during follow-up, including 19 hips with stage II (1.34%), 162 hips with stage III (24.4%), and 34 hips with stage IV (34.3%).The mean HHS at the end of follow-up was significantly improved when compared to preoperative mean HHS (83.63 ± 5.03 vs. 66.54 ± 6.05, P < .001). CONCLUSIONS: In this evaluation of a large series of cases, the vascularized iliac bone flap transfer showed good results for arresting the osteonecrosis progress and improving the hip function of patients with pre-collapse stages of ONFH.
BACKGROUND:Osteonecrosis of the femoral head (ONFH) often affects young active adults and leads to destruction of the hip joint and disabling arthritis. Several procedures have been developed to arrest the progress of osteonecrosis and postpone the procedure of total hip replacement especially in young patients. The aim of this multicenter study was to analyze the results of the use of the vascularized iliac bone flap transfer for management of ONFH. METHODS: From January 1985 to December 2012, a total of 2190 patients (2690 hips) with the mean age of 43.15 years (ranging from 18 to 65 years) underwent hip-preserving surgery with the pedilced iliac bone flap transfer for management of ONFH with Ficat and Arlet stage II-IV in 8 hospitals. There were 1733 hips in stage II, 776 hips in stage III, and 181 hips in stage IV preoperatively. The complications were recorded. The outcomes were evaluated by radiograph, the Harris hip-scoring system (HHS). RESULTS:Postoperative complications occurred in 128 patients (5.84%). Among them, 25 patients had deep venous thromboses, 16 patients had sensory deficits, 40 patients had superficial infection and hematoma, and 47 patients had wound dehiscence. A total of 1912 patients (2179 hips) were followed up with a median time of 12 years (ranging from 5 to 25 years). There were 1787 hips with no radiographic osteonecrotic progress during follow-up, while osteonecrosis progress was observed in 186 hips with stage II (13.1%), 170 hips with stage III (25.6%) and 36 hips with stage IV (36.4%; P < .001). Two hundred fifteen hips (9.87%) in 203 patients were converted to THA during follow-up, including 19 hips with stage II (1.34%), 162 hips with stage III (24.4%), and 34 hips with stage IV (34.3%).The mean HHS at the end of follow-up was significantly improved when compared to preoperative mean HHS (83.63 ± 5.03 vs. 66.54 ± 6.05, P < .001). CONCLUSIONS: In this evaluation of a large series of cases, the vascularized iliac bone flap transfer showed good results for arresting the osteonecrosis progress and improving the hip function of patients with pre-collapse stages of ONFH.
Authors: Michael A Mont; Hytham S Salem; Nicolas S Piuzzi; Stuart B Goodman; Lynne C Jones Journal: J Bone Joint Surg Am Date: 2020-06-17 Impact factor: 6.558