Zunhan Liu1, Xuetao Yang1, Yuhan Li1, Wei-Nan Zeng1, Enze Zhao1, Zongke Zhou2. 1. Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China. 2. Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China. zhouzongke@scu.edu.cn.
Abstract
BACKGROUND: To determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH). METHODS: We identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling. RESULTS: Kaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8-83.4%) and the natural course group (72.2, 95% confidence interval 64.8-79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05). CONCLUSIONS: Multiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH. TRIAL REGISTRATION: The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR2000035180 ) dated 2 August 2020.
BACKGROUND: To determine whether multiple drilling is effective in postponing the need for total hip arthroplasty (THA) in early-stage nontraumatic osteonecrosis of the femoral head (ONFH). METHODS: We identified 514 patients who were diagnosed with early-stage ONFH between January 2008 and December 2018. One hundred ninety-six patients underwent multiple drilling, and 318 patients had a natural course of progression. One hundred fifty-nine patients were selected for each group after case-control matching for preoperative demographics and modified Ficat and Arlet stage. The rates of THA conversion were compared. We also performed Cox regression to identify risk factors associated with THA conversion in patients who underwent multiple drilling. RESULTS: Kaplan-Meier survivorship with an endpoint of THA for nontraumatic reasons were not significantly different between the multiple drilling group (75.6, 95% confidence interval 67.8-83.4%) and the natural course group (72.2, 95% confidence interval 64.8-79.6%) at 5 years (log-rank, P = .191). In the Cox regression model, a larger extent of necrotic lesion, bone marrow edema (BME), and higher postoperative work intensity significantly increased the risk of THA conversion (P < .05). Among patients treated with autogenous bone grafting, there was a lower risk of failure in patients with necrotic lesion less than 15% (P < .05). CONCLUSIONS: Multiple drilling is not effective in reducing the rate of THA conversion in early-stage nontraumatic ONFH. The risk of conversion to THA after multiple drilling is increased by a larger extent of necrotic lesion, presence of BME, and higher postoperative work intensity in patients with early-stage ONFH. TRIAL REGISTRATION: The trial was registered in the Chinese Clinical Trial Registry ( ChiCTR2000035180 ) dated 2 August 2020.
Entities:
Keywords:
Autogenous bone grafting; Multiple drilling; Osteoarthritis; Risk factors; Total hip arthroplasty
Authors: Adam Hart; Viktor Janz; Robert T Trousdale; Rafael J Sierra; Daniel J Berry; Matthew P Abdel Journal: J Bone Joint Surg Am Date: 2019-09-04 Impact factor: 5.284
Authors: A Roth; J Beckmann; K Bohndorf; A Fischer; C Heiß; W Kenn; M Jäger; U Maus; U Nöth; K M Peters; C Rader; S Reppenhagen; U Smolenski; M Tingart; I Kopp; I Sirotin; S J Breusch Journal: Arch Orthop Trauma Surg Date: 2015-12-14 Impact factor: 3.067
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
Authors: Camilla Bergh; Ann M Fenstad; Ove Furnes; Göran Garellick; Leif I Havelin; Søren Overgaard; Alma B Pedersen; Keijo T Mäkelä; Pekka Pulkkinen; Maziar Mohaddes; Johan Kärrholm Journal: Acta Orthop Date: 2013-12-20 Impact factor: 3.717