Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
Clin Orthop Surg. 2020 Jun;12(2):151-157. doi: 10.4055/cios19033. Epub 2020 May 6.
Untreated osteonecrosis of the femoral head ultimately leads to secondary coxarthrosis. The aim of this study was to determinate if the core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate could be used to prevent radiographic progression of early stage osteonecrosis of the hip. We also sought to determine whether this treatment improved clinical outcomes and reduced the need for total hip arthroplasty.
Eighteen hips were included in the present study. All of them underwent core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate between 2007 and 2012. The cell concentrate was obtained from the posterior iliac crest and processed and implanted during the same surgical procedure. Patient demographic data, clinical data including modified Harris hip score, and radiological data were collected preoperatively, postoperatively, and during the follow-up period. Also, survival endpoints were analyzed: time of femoral head collapse and need for total hip arthroplasty.
The mean age of patients was 37.8 years (standard deviation [SD], 9.31 years). The mean follow-up was 68.9 months (SD, 15.0 months). In most cases (70.6%), the etiology of the osteonecrosis of the femoral head was corticosteroid use; in the remaining cases, secondary to alcohol use. Core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate did not prevent progression to collapse (< 80% at 5 years) although modified Harris hip scores improved. Overall median survival with the total hip arthroplasty as endpoint was 23 months (95% confidence interval [CI], 14.9 to 31.1 months). Overall median survival time with any degree of collapse as endpoint was 7 months (95% CI, 2.0 to 12.0 months).
The results obtained in this study suggest that core decompression combined with implantation of autologous bone marrow concentrate and tricalcium phosphate will not prevent radiographic progression of early stage osteonecrosis of the hip. These finding also suggest that the absence of indications for hip replacement alone is not an indicator of good response to the treatment, and it is important to note the radiological results.
未治疗的股骨头坏死最终会导致继发性髋关节骨关节炎。本研究旨在确定股骨头髓芯减压联合磷酸三钙自体骨髓浓缩物植入是否可用于预防早期髋关节骨坏死的影像学进展。我们还试图确定这种治疗是否改善了临床结果并减少了全髋关节置换的需求。
本研究纳入了 18 髋。所有患者均于 2007 年至 2012 年间接受了股骨头髓芯减压联合磷酸三钙自体骨髓浓缩物植入术。细胞浓缩物取自髂后嵴，在同一手术过程中进行处理和植入。收集患者的人口统计学数据、包括改良 Harris 髋关节评分在内的临床数据以及影像学数据，分别在术前、术后和随访期间进行。此外，还分析了生存终点：股骨头塌陷时间和全髋关节置换术的需求。
患者的平均年龄为 37.8 岁（标准差[SD]，9.31 岁）。平均随访时间为 68.9 个月（SD，15.0 个月）。在大多数情况下（70.6%），股骨头坏死的病因是皮质类固醇的使用；在其余情况下，病因是酒精。尽管改良 Harris 髋关节评分有所改善，但股骨头髓芯减压联合磷酸三钙自体骨髓浓缩物植入并不能预防进展为塌陷（5 年内＜80%）。以全髋关节置换术为终点的总体中位生存时间为 23 个月（95%置信区间[CI]，14.9 至 31.1 个月）。以任何程度的塌陷为终点的总体中位生存时间为 7 个月（95%CI，2.0 至 12.0 个月）。
本研究结果表明，股骨头髓芯减压联合磷酸三钙自体骨髓浓缩物植入并不能预防早期髋关节骨坏死的影像学进展。这些发现还表明，单独没有髋关节置换的指征并不是对治疗有良好反应的指标，注意影像学结果很重要。
