Wang Tianyu, Wang Zhongzheng, Wang Yuchuan, Li Changhui, Lu Yining, Zhu Yanbin, Chen Wei, Zhang Xuebin, Zhang Yingze
Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, NO.139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People's Republic of China.
School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.
BMC Musculoskelet Disord. 2025 Jul 21;26(1):695. doi: 10.1186/s12891-025-08869-5.
Association Research Circulation Osseous (ARCO) stage III is the last chance for joint preservation in patients with osteonecrosis of the femoral head (ONFH). As the femoral head has collapsed at this stage, existing hip-preserving surgical treatments show limited success. We aimed to introduce a new surgical technique called partial femoral head replacement for the treatment of ARCO III femoral head necrosis and to evaluate its safety and efficacy.
Between November 2022 and December 2022, 11 symptomatic hips from 11 patients were enrolled in this retrospective study. The surgeon precisely removed the necrotic area of the femoral head through a bone tunnel at the femoral neck and implanted a prosthesis that matched each patient's anatomy and femoral head contour. Details of the demographics, surgical information, imaging findings, and any complications were retrospectively collected. Clinical scores, including the visual analogue scale (VAS) score, Harris Hip Score (HHS), and 12-Item Short-Form Health Survey (SF-12) scores, were determined. Each patient was followed for at least one year.
The mean operative time per hip was 57.27 ± 15.23 min, the mean estimated blood loss was 110 ± 60.62 ml, and the mean incision length was 3.35 ± 0.38 cm. The VAS score at the one-year follow-up showed great pain relief (7.5 ± 0.9 vs. 1.6 ± 1.2, P < 0.01). The HHS improved significantly compared to the preoperative score (90.3 ± 3.7 vs. 42.9 ± 4.4, P < 0.01). The SF-12 scores also showed that all patients experienced varying degrees of physical (42.1 ± 5.1 vs. 27.7 ± 7.1, P<0.01) and mental (44.3 ± 4.7 vs. 36.4 ± 3.8, P<0.01) health improvement. Radiologically, there were no abnormalities on the latest imaging examination. Clinically, no serious postoperative complications occurred during the treatment.
Our preliminary clinical results showed that partial femoral head replacement was a safe and effective method for the treatment of ARCO III femoral head necrosis. With the trend of younger ONFH patients and increasing emphasis on hip preservation, partial femoral head replacement may provide a new minimally invasive hip-preserving option for these patients.
骨循环协会（ARCO）III期是股骨头坏死（ONFH）患者保留关节的最后机会。由于在此阶段股骨头已经塌陷，现有的保髋手术治疗效果有限。我们旨在引入一种名为部分股骨头置换的新手术技术来治疗ARCO III期股骨头坏死，并评估其安全性和有效性。
在2022年11月至2022年12月期间，本回顾性研究纳入了11例患者的11个有症状的髋关节。外科医生通过股骨颈的骨隧道精确切除股骨头的坏死区域，并植入与每个患者的解剖结构和股骨头轮廓相匹配的假体。回顾性收集人口统计学、手术信息、影像学检查结果及任何并发症的详细信息。测定临床评分，包括视觉模拟量表（VAS）评分、Harris髋关节评分（HHS）和12项简明健康调查（SF - 12）评分。对每位患者至少随访一年。
每个髋关节的平均手术时间为57.27±15.23分钟，平均估计失血量为110±60.62毫升，平均切口长度为3.35±0.38厘米。一年随访时的VAS评分显示疼痛明显缓解（7.5±0.9对1.6±1.2，P<0.01）。与术前评分相比，HHS显著改善（90.3±3.7对42.9±4.4，P<0.01）。SF - 12评分也表明所有患者在身体（42.1±5.1对27.7±7.1，P<0.01）和精神（44.3±4.7对36.4±3.8，P<0.01）健康方面都有不同程度的改善。影像学上，最新的影像学检查未发现异常。临床上，治疗期间未发生严重的术后并发症。
我们的初步临床结果表明，部分股骨头置换是治疗ARCO III期股骨头坏死的一种安全有效的方法。随着ONFH患者年轻化的趋势以及对保髋的日益重视，部分股骨头置换可能为这些患者提供一种新的微创保髋选择。
