Outcome of the treatment of osteonecrosis of femoral head using the core decompression with bone impaction grafting.

OBJECTIVE

To evaluate the outcome of core decompression with bone impaction grafting for the treatment of osteonecrosis of femoral head.

METHODS

Totally 39 cases (46 hips) of osteonecrosis of femoral head were treated with core decompression and impaction bone grafting. According to the Association Research Circulation Osseous (ARCO) system, 3 hips were graded for stage 1,16 for stage 2a,7 for 2b,11 for 2c, and 9 for 3.The Harris hip score (HHS) was evaluated before operation and at the latest follow-up.

RESULTS

In all these patients, 22 hips had hormone-related lesions, 11 had alcohol-related lesions, and 13 had idiopathic lesions. The average HHS was changed from (66 ± 6.6) before surgery to (80.2 ± 9.7) after surgery during an average follow-up of 26 months(from 9 to 48 months). The postoperative HHS showed no significant difference among osteonecrosis of femoral head due to different etiologies.Also,the postoperative HHS and clinical effectiveness were not significantly different among patients with different preoperative stages.The postoperative outcome was excellent in 7 cases, good in 23 cases, mild in 4 cases,and poor in 12 cases. The rate of excellent and good was 65% in this series,with 78% for patients with early stages and 52.6% for those with grade 2c or higher lesions. The femoral head collapsed in 7 cases,and 5 of which were preoperatively graded as in stage 2c and higher. The postoperative complications included intertrochanteric fracture (n=1) and infection (n=1). Four hips were converted to total hip arthroplasty. All of other hips had no obvious progression of osteonecrosis.

CONCLUSIONS

Core decompression with bone impaction allografting is effective for the treatment of osteonecrosis of femoral head. Patients with lesions in earlier ARCO stages can have better outcomes.