Effect of Osteonecrosis Intervention Rod Versus Core Decompression Using Multiple Small Drill Holes on Early Stages of Necrosis of the Femoral Head: A Prospective Study on a Series of 60 Patients with a Minimum 1-Year-Follow-Up

Abstract

Introduction: The conventional CD used 10 mm drill holes associated with a lack of structural support. Thus, alternative methods such as a tantalum implant, small drill holes, and biological treatment were developed to prevent deterioration of the joint. The treatment of CD by multiple 3.2 mm drill holes could reduce the femoral neck fracture and partial weight bearing was allowed. This study was aimed to evaluate the effect of osteonecrosis intervention rod versus core decompression using multiple small drill holes on early stages of necrosis of the femoral head.Method: From January 2011 to January 2012, 60 patients undergoing surgery for osteonecrosis with core decompression were randomly assigned into 2 groups based on the type of core decompression used: (1) a total of 30 osteonecrosis patients (with 16 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with a porous tantalum rod insertion. The diameter of the drill hole for the intervention rod was 10mm.(2) a total of 30 osteonecrosis patients (with 14 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with core decompression using five drill holes on the lateral femur, the diameter of the hole was 3.2 mm. The average age of the patient was 32.6 years (20-45 years) and the average time of follow-up was 25.6 months (12- 28 months) in the rod implanted group. The average age of the patient was 35.2 years (22- 43 years) and the average time of follow-up was 26.3 months (12-28 months) in the small drill holes group.Results: The average of surgical time was 40 min, and the mean volume of blood loss was 30 ml in both surgical groups. The average of Harris score was improved from 56.2 ± 7.1 preoperative to 80.2 ± 11.4 at the last follow-up in the rod implanted group (p < 0.05). The mean Harris score was improved from 53.8 ± 6.6 preoperative to 79.7 ± 13.2 at the last follow-up in the small drill holes group (p<0. 05). No significant difference was observed in Harris score between the two groups. At the last follow-up, 28 of 36 hips were at the same radiographic stages as pre-operation, and 8 deteriorated in the rod implanted group. 26 of 34 hips were at the same radiographic stage as pre-operation, and 8 deteriorated in the small drill holes group. No significant difference was observed in radiographic stage between the two groups. There was no favourable result on the outcome of a tantalum intervention implant compared to multiple small drill holes.Discussion: CD via multiple small drill holes would allow similar postoperative load-bearing and seems to result in similar or even better clinical outcome without the prolonged implantation of an expensive tantalum implant. A tantalum rod intervention and core decompression using multiple small drill holes were effective on the stage I hips rather than stage II hips.

Clinical Study on the Minimally Invasive Treatment of Early Necrosis of the Femoral Head With Hydroxyapatite Coated Hollow Titanium Rod Supporting the Femoral Head to Prevent Collapse

“…At present, there is no clear report that tantalum rods can help promote bone repair. Meanwhile, with the in-depth study of tantalum rods, the number of cases of their failure increases gradually and it is di cult to remove the titanium rod [12,13]. Therefore, nding a minimally invasive method with the ability to repair the bone defect in the necrotic area of the femoral head and the ability to provide immediate and permanent structural support to prevent the collapse of the femoral head is the key to the early ONFH head preserving treatment [14].…”

Comparison of core decompression and porous tantalum rod implantation with conservative treatment for avascular necrosis of the femoral head: A minimum 18�month follow‑up study

“…A prospective study compared core decompression with tantalum rod insertion in 60 patients. No favourable results were observed for the tantalum rod compared with multiple small drill holes (35). An additional study assessed survivorship and prognostic factors for radiographic progression and conversion to THA after tantalum rod implantation (36).…”

“…Considering that a tantalum rod can only serve a point supporting role (diameter; 10 mm), it is not suitable for patients with multiple foci and a large necrosis area (43). Another disadvantage of the tantalum rod is that it is expensive and as a foreign body implant, it may require removal when deep tissue infection occurs which will increase the risk of fracture (35). After the failure of tantalum rod implantation, it was converted to THA.…”

Bone Regeneration Therapy of Atraumatic Necrosis of Femoral Head

“…Another group of the researcher used tantalum rods in an advanced stage of stage 2 and 3 of FHN, in combination with bone marrow and autologous bone grafts. After 5 y of treatment only 3 and 15 % of cases in stages II and III, respectively were further shifted to total hip replacement [61][62][63] .…”