Difference in Therapeutic Strategies for Joint‐Preserving Surgery for Non‐Traumatic Osteonecrosis of the Femoral Head between the United States and Japan: A Review of the Literature

Abstract

For patients with non‐traumatic osteonecrosis of the femoral head (ONFH), core decompression (CD) and bone grafts (BG) are mainly performed in the West, while osteotomy is found to be predominant in Japan. It is not well recognized how the surgical procedures for joint preservation in patients with ONFH are completely different between the United States and Japan. This paper identifies the contexts and the differences in treatment strategies for ONFH between the two countries. We compared the surgical trends of the two countries over three periods, 1997–2001, 2002–2006, and 2007–2011 (the US data for the third period was 2007–2008), based on a 2014 US paper and a 2013 national publication in Japan. We compared the details of surgery for non‐traumatic ONFH under the same conditions in the two reports. For the period 1997–2001, the rates of surgeries for ONFH in the US were as follows: total hip arthroplasty (THA), 86%; CD, 10%; and osteotomy, 0.4%. In Japan, THA was 61%, osteotomy 38%, and CD 0%. For the recent period, 2007–2011 (US 2007–2008), the rate of THA was 91%, CD 6%, and osteotomy 0.1%, in the US, compared to a THA rate of 73%, CD 0%, and osteotomy 26% in Japan. The results for the interim period (2002–2006) were between the old and new data. The use of joint‐preserving surgery for ONFH differs greatly between the US and Japan. The first‐line joint‐preserving surgery was CD in the US and osteotomy in Japan. Each procedure was rarely done in the other country. From about 2000 to 2010, the percentage of THA increased in both countries. The proportion of joint‐preserving surgery (CD in the US and osteotomy in Japan) declined. The decrease in joint‐preserving procedures may be largely attributed to improved long‐term outcomes of THA due to technological advances. There is also a reluctance for young ONFH patients to undergo joint‐preserving procedures, such as osteotomy, that require long‐term hospitalization.

Outcomes of surgical hip dislocation combined with bone graft for adolescents and younger adults with osteonecrosis of the femoral head: a case series and literature review

“…Preserving the patient's own hip joint and prolonging the service life of the joint has always been the goal pursued by clinicians. In the West, the most commonly used methods for adult hip preservation are core decompression (CD) and bone grafting [ 31 ], but the collapse rate of such minimally invasive hip preservation surgery is as high as 50% at two years after operation [ 32 ]. In addition, for patients with large necrosis or ARCO stage III/IV, nonsurgical hip preservation or CD often cannot prevent progressive collapse of the femoral head [ 33 – 35 ].…”

“…In addition, for patients with large necrosis or ARCO stage III/IV, nonsurgical hip preservation or CD often cannot prevent progressive collapse of the femoral head [ 33 – 35 ]. THA is considered to be the ultimate method for advanced ONFH and secondary end-stage osteoarthritis [ 31 ]. For children with avascular necrosis of the femoral head, studies have shown that conservative treatment can achieve good results in a large proportion of patients [ 36 – 40 ].…”

Treatment of non‑traumatic avascular necrosis of the femoral head (Review)

“…The number of cases opting for THA is increasing, which can be attributed to the improvements in long-term efficacy. Furthermore, younger patients with ONFH are unwilling to undergo joint-sparing surgery that requires long-term hospitalization ( 143 ). Thus, joint replacement surgery is currently the most preferred treatment method for advanced NONFH.…”

lncRNA FGD5-AS1 Regulates Bone Marrow Stem Cell Proliferation and Apoptosis by Affecting miR-296-5p/STAT3 Axis in Steroid-Induced Osteonecrosis of the Femoral Head

“…According to statistics from the World Health Organization, the age of patients with ONFH is mostly between 30 and 50 years old. Also, the incidence rate of ONFH is gradually increasing with age [ 4 ]. This disease is more harmful.…”