Yokota Shunichi, Shimizu Tomohiro, Ishizu Hotaka, Sugawara Yutaro, Ohashi Yusuke, Asano Tsuyoshi, Takahashi Daisuke, Iwasaki Norimasa
Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan.
J Hip Preserv Surg. 2025 Feb 6;12(2):125-133. doi: 10.1093/jhps/hnaf005. eCollection 2025 Jul.
Osteonecrosis of the femoral head (ONFH) often leads to femoral head collapse, which makes joint preservation challenging. Although curved varus osteotomy (CVO) is an effective surgical method for joint preservation in young ONFH patients, there are some cases where it cannot prevent femoral head collapse. This research aims to evaluate the usefulness of teriparatide (TPD) in bone healing and preventing femoral head collapse in CVO-treated ONFH patients. This retrospective study included 48 patients (56 hips) diagnosed with ONFH, categorized into three groups: glucocorticoid-associated ONFH with TPD treatment (GCs + TPD), glucocorticoid-associated ONFH (GCs), and alcohol- associated ONFH (Alc). No significant differences were found in terms of surgical details, stage, conversion to total hip arthroplasty (THA), and clinical scores. The GCs + TPD group showed a shorter bone union duration, reduced femoral head collapse, and a lower incidence of advanced collapse than the other groups. Lower BMI and TPD use were associated with a shorter duration of bone union. TPD and union duration were identified as factors contributing to the advanced collapse. In conclusion, TPD administration accelerates bone union at the osteotomy site and mitigates femoral head collapse after joint-preserving osteotomy. In addition, combining TPD with CVO may be a promising strategy for younger patients.
股骨头坏死（ONFH）常导致股骨头塌陷，这使得保留关节具有挑战性。尽管内翻弧形截骨术（CVO）是年轻ONFH患者保留关节的有效手术方法，但在某些情况下它无法预防股骨头塌陷。本研究旨在评估特立帕肽（TPD）在CVO治疗的ONFH患者骨愈合及预防股骨头塌陷方面的有效性。这项回顾性研究纳入了48例诊断为ONFH的患者（56髋），分为三组：糖皮质激素相关性ONFH且接受TPD治疗组（GCs + TPD）、糖皮质激素相关性ONFH组（GCs）和酒精相关性ONFH组（Alc）。在手术细节、分期、转为全髋关节置换术（THA）及临床评分方面未发现显著差异。与其他组相比，GCs + TPD组的骨愈合时间更短，股骨头塌陷减少，晚期塌陷发生率更低。较低的体重指数（BMI）和使用TPD与较短的骨愈合时间相关。TPD和骨愈合时间被确定为导致晚期塌陷的因素。总之，给予TPD可加速截骨部位的骨愈合，并减轻保留关节截骨术后的股骨头塌陷。此外，将TPD与CVO联合应用可能是年轻患者的一种有前景的策略。
