Department of Orthopaedics and Traumatology, University of Duisburg-Essen, Essen, Germany.
Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany.
J Tissue Eng Regen Med. 2019 Apr;13(4):546-554. doi: 10.1002/term.2794. Epub 2019 Feb 22.
Osteonecrosis of the femoral head (ONFH) and CAM-type femoroacetabular impingement (FAI) present two different pathologies of the hip joint. The aim of this study is to describe the prevalence of CAM-FAI in a collective of ONFH hips and to evaluate its influence on ONFH therapy outcome. A cohort of 86 ONFH hips with a mean follow-up of 46.7 months (±20.5) after advanced core decompression (ACD) was evaluated regarding CAM deformity by measuring the alpha angle (α) and head-neck offset. The influence of CAM-type FAI was investigated using the Kaplan-Meier estimator and the Cox regression model. The mean α was 60.4° (±13.8) with 41 hips (47.7%) being ≥60°. The mean head-neck offset was 4.5 mm (±3.2), with 78 hips (90.7%) being ≤9 mm. Survival analysis indicated noticeably better ACD results for α < 60° versus α ≥ 60° (p = 0.07). Treatment failure within the first 2 years was statistically estimated as 27.7% for α < 60° versus 40.7% for α ≥ 60°: The hazard ratio for α ≥ 60° was 1.94. Head-neck offset-dependent survival showed better, though not significant, results for offset >9 mm (p = 0.38, hazard ratio 1.89 for offsets ≤9 mm). The prevalence of CAM-type deformity is greatly increased in patients with concomitant ONFH. There is a strong indication that CAM-type FAI has a negative influence on ONFH therapy outcome. The risk that ONFH treatment will fail seems to be twice as high for α ≥ 60° as for α < 60°. We recommend cotreatment of pathological head-neck offset in patients with ONFH.
股骨头坏死（ONFH）和 CAM 型股骨髋臼撞击症（FAI）是髋关节的两种不同病理类型。本研究旨在描述髋关节撞击症（FAI）在股骨头坏死（ONFH）髋关节中的患病率，并评估其对 ONFH 治疗效果的影响。对 86 例接受先进的核心减压术（ACD）治疗的 ONFH 髋关节进行了前瞻性队列研究，平均随访时间为 46.7±20.5 个月。通过测量 α 角（α）和头-颈偏移来评估 CAM 畸形。使用 Kaplan-Meier 估计器和 Cox 回归模型研究了 CAM 型 FAI 的影响。平均 α 角为 60.4°±13.8°，41 髋（47.7%）≥60°。平均头-颈偏移为 4.5mm±3.2mm，78 髋（90.7%）≤9mm。生存分析表明，α<60°的 ACD 结果明显优于α≥60°（p=0.07）。在最初 2 年内，α<60°的治疗失败率为 27.7%，而α≥60°的治疗失败率为 40.7%：α≥60°的危险比为 1.94。头-颈偏移依赖性生存分析显示，偏移>9mm 的结果较好，但无统计学意义（p=0.38，偏移≤9mm 的危险比为 1.89）。伴有 ONFH 的患者中，CAM 型畸形的患病率大大增加。有强烈的迹象表明，CAM 型 FAI 对 ONFH 治疗效果有负面影响。对于α≥60°的患者，ONFH 治疗失败的风险似乎是α<60°的两倍。我们建议对伴有 ONFH 的患者进行病理性头-颈偏移的联合治疗。
