Early results of a novel technique using multiple small tantalum pegs for the treatment of osteonecrosis of the femoral head

Abstract

The introduction of a trabecular tantalum rod has been proposed for the management of early-stage osteonecrosis of the femoral head but serves as a single-point of support of the necrotic lesion. We describe a technique using two or three 4.2 mm (or later 4.7 mm) tantalum pegs for the prevention of collapse of the necrotic lesion. We prospectively studied 21 patients (26 hips) with non-traumatic osteonecrosis of the femoral head treated in this manner. Of these, 21 patients (24 hips) were available for radiological and clinical evaluation at a mean follow-up of 46 months (18 to 67). Radiological assessment showed that only eight hips deteriorated according to the Association Research Circulation Osseous classification, and four hips according to the Classification of the Japanese Investigation Committee of Health and Welfare. Functional improvement was obtained with an improvement in the mean Harris hip score from 65.2 (33.67 to 95) to 88.1 (51.72 to 100), the mean Merle D'Aubigné-Postel score from 13 (6 to 18) to 16 (11 to 18), a mean visual analogue score for pain from 5.2 (0 to 9.5) to 2.6 (0 to 7), and the mean Short-Form 36 score from 80.4 (56.8 to 107.1) to 92.4 (67.5 to 115.7). Of these 24 hips followed for a minimum of 18 months, three were considered as failures at the final follow-up, having required total hip replacement. One of the hips without full follow-up was also considered to be a failure. In more than two-thirds of the surviving hips a satisfactory clinical outcome was achieved with promising radiological findings. The estimated mean implant survival was 60 months (95% confidence interval 53.7 to 66.3).

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

“…Emerging technologies that improve the treatment of ONFH have been described [1,2,12]. An implant developed specifically to treat osteonecrosis is intended to improve the treatment of early-and intermediate-stage ONFH [14][15][16][17][18], with possible benefits to include the advantages of core decompression (i.e., reduction of intraosseous pressure, and reperfusion with the possibility of regeneration [5,6]) as well as structural support, early post-operative load bearing, low donor-site morbidity, and minimal invasion [14][15][16][17][18].…”

“…Operative management of ONFH includes joint-salvage procedures such as proximal femoral rotational osteotomy, core decompression sequestrectomy and replacement with bone grafting, non-vascularized cancellous or cortical bone grafting of the lesion, muscle-pedicle bone grafting, free vascularized fibular grafting, and multiple small tantalum pegs [3][4][5][6][7][8][9][10][11][12]. Of these, the most commonly used procedures are core decompression combined with impaction grafting of composite bone material.…”

A pilot study of regenerative therapy using controlled release of recombinant human fibroblast growth factor for patients with pre-collapse osteonecrosis of the femoral head

“…Autologous bone marrow cell transplantation may be reliable for the treatment of the precollapse stage of ONFH [4][5][6]. Implantation of cylindrical metal (porous tantalum) rods into the femoral head can prevent collapse by providing structural support in the necrotic area, which has been approved as an early-stage therapy [21,22]. However, we believe that direct administration of rhFGF-2-impregnated gelatin hydrogel offers the important advantages of not only being a minimally invasive percutaneous technique that facilitates early return to society but also being able to promote bone regeneration in necrotic areas.…”

Autologous (non-vascularised) fibular grafting with recombinant bone morphogenetic protein-7 for the treatment of femoral head osteonecrosis

“…In primary stages (Steinberg I) core decompression is recommended, while in pre-collapse stages (Steinberg II, III) implantation of tantalum pegs, osteotomies and autologous bone grafting have been undertaken to prevent collapse and avoid the need for THR. 1,[5][6][7][8][9] Autologous fibular implantation in femoral head necrosis combines several procedures such as excision of necrotic bone, core decompression that relieves intraosseous pressure, and implantation of a cortico-cancellous graft with biological (osteoinductive) and mechanical properties (support of subchondral surface). 10 When the fibular graft is vascularised, the overall process of revascularisation of the affected area is promoted.…”