Ansari Sajid, Gupta Kshitij, Bondarde Parshwanath, Madhusudan Ch Raja Bhaskar Venkatasai, Kalia R B
Department of Orthopaedics, All India Institute of Medical Sciences, Kalyani, West Bengal 741245, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Dehradun 249203, India.
J Hip Preserv Surg. 2024 Nov 8;11(4):280-286. doi: 10.1093/jhps/hnae027. eCollection 2024 Dec.
Osteonecrosis of femoral head (ONFH) can be a debilitating disease, for which numerous salvage surgeries have been popularized to halt its progression. The aim of this study was to assess the clinical and radiological outcomes of a single-incision core decompression (CD) technique using trochanteric autograft in ONFH and to determine the prognostic factors of treatment success. Sixty-six hips (41 patients) of Association Research Circulation (ARCO) 1 and 2 ONFH undergoing CD were included in the study with a mean follow-up of 58 months. Treatment failure was taken as radiographic collapse and/or conversion to total hip arthroplasty (THA). The following clinical and radiological factors impacting outcomes were evaluated-symptom duration, etiology, age, sex and body mass index, ARCO grade, Japanese Investigation Committee grade, modified Kerboul angle, and bone marrow edema (BME) on magnetic resonance imaging. Twenty-one of the 66 hips (31.8%) had a radiological collapse by the last follow-up, and 6 hips (9%) required THA. Overall, significant improvement in Harris hip scores (60.18 versus 80.81, -value = .012) and visual analog scale scores (7.3 versus 1.2, -value = .025) were noted postoperatively with no surgical complications. Late presentation (>3 months) (-value = .001) and presence of BME ( = 0.0002) were significantly correlated with poor outcomes. The 5-year collapse-free rate was 68.2%, and 91% hips were arthroplasty free. Our single-incision CD technique using a trochanteric autograft yielded favorable outcomes for precollapse stages of nontraumatic ONFH at 5-year follow-up. Delayed presentation and presence of BME are poor prognostic factors. Adequate patient selection is for achieving a good survivorship and improvement in patient-reported outcomes.
股骨头坏死（ONFH）可能是一种使人衰弱的疾病，针对这种疾病，已经推广了许多挽救性手术来阻止其进展。本研究的目的是评估采用转子自体骨移植的单切口髓芯减压（CD）技术治疗ONFH的临床和影像学结果，并确定治疗成功的预后因素。本研究纳入了66例（41例患者）接受CD治疗的国际骨循环研究协会（ARCO）1期和2期ONFH患者，平均随访58个月。治疗失败定义为影像学上的塌陷和/或转为全髋关节置换术（THA）。评估了以下影响结果的临床和影像学因素：症状持续时间、病因、年龄、性别和体重指数、ARCO分级、日本调查委员会分级、改良Kerboul角以及磁共振成像上的骨髓水肿（BME）。66例髋关节中，有21例（31.8%）在最后一次随访时出现影像学塌陷，6例（9%）需要进行THA。总体而言，术后Harris髋关节评分（从60.18提高到80.81，P值=0.012）和视觉模拟量表评分（从7.3降至1.2，P值=0.025）有显著改善，且无手术并发症。症状出现较晚（>3个月）（P值=0.001）和存在BME（P=0.0002）与预后不良显著相关。5年无塌陷率为68.2%，91%的髋关节无需进行关节置换术。我们采用转子自体骨移植的单切口CD技术在5年随访时，对于非创伤性ONFH的塌陷前期阶段产生了良好的结果。症状出现延迟和存在BME是不良预后因素。充分的患者选择对于实现良好的生存率和改善患者报告的结果至关重要。
