Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course

Liu, Zunhan; Yang, Xuechao; Li, Yuhan; Zeng, Wenbin; Zhao, Enze; Zhou, Zongke

doi:10.1186/s12891-021-04418-y

Cited by 5 publications

(5 citation statements)

References 45 publications

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“…In 1990, some scholars reported 53 patients with acetabular fractures, 55 hips were treated with THA, and 13 patients were treated with open reduction and internal fixation and were followed up for 7.5 years [ 22 ]. Finally, 10 patients needed revision surgery [ 23 ]. In terms of conventional THA, due to scar tissue, formation of ectopic ossification, obstruction of internal fixation, and so on, the survival rate of the prosthesis is lower [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Logistic Regression Analysis of Risk Factors and Improvement of Clinical Treatment of Traumatic Arthritis after Total Hip Arthroplasty (THA) in the Treatment of Acetabular Fractures

Zhang

Feng²

2022

Computational and Mathematical Methods in Medicine

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Objective. Logistic regression was adopted to analyze the risk factors of traumatic arthritis after total hip arthroplasty (THA) in the treatment of acetabular fractures, and the clinical treatment was enhanced. Methods. A total of 200 patients with acetabular fractures treated in our hospital from February 2019 to April 2021 were enrolled for THA. According to the occurrence of traumatic arthritis after operation, the patients were divided into control group and study group. The control group was patients without traumatic arthritis ( n = 165 ), and the study group was patients with traumatic arthritis after operation ( n = 35 ). The general data were analyzed, the risk factors of traumatic arthritis after THA for acetabular fractures were analyzed by logistic regression, and the clinical treatment methods were promoted. Results. First of all, there exhibited no significant difference in the general data such as sex, age, medical history, and operation site ( P > 0.05 ). There were significant differences in the general data of whether the patients had a job, rehabilitation exercise, and osteoarthritis before operation ( P < 0.05 ). Secondly, we compared the curative effects between two groups. The effective rate in the study group was higher compared to the control group ( P < 0.05 ). After treatment, the Harris hip function score of the study group at discharge, 1 month, 3 months, and 6 months after discharge was higher compared to that of the control group ( P < 0.05 ). The incidence of postoperative complications in the study group was significantly higher compared to that in the control group ( P < 0.05 ). The presence of osteoarthritis, curative effect, poor reduction of fracture, injury of articular cartilage, entry of internal fixation into the joint, avascular necrosis of the femoral head, and infection before operation were significantly correlated with traumatic arthritis after THA in the treatment of acetabular fractures ( P < 0.05 ). Logistic regression analysis indicated that poor reduction, curative effect, articular cartilage injury, entry of internal fixation into the joint, avascular necrosis of the femoral head, infection, and preoperative osteoarthritis were the risk factors of traumatic arthritis after THA in the treatment of acetabular fractures ( P < 0.05 ). Conclusion. Poor fracture reduction, curative effect, articular cartilage injury, internal fixation into the joint, avascular necrosis of the femoral head, infection, and the presence of osteoarthritis before operation are the risk factors of traumatic arthritis after THA in the treatment of acetabular fractures. When performing THA for patients with acetabular fracture, attention should be paid to the presence of osteoarthritis before operation, and for those with poor curative effect, attention should be paid to the occurrence of poor fracture reduction, articular cartilage injury, internal fixation into the joint, avascular necrosis of the femoral head, and combined infection, and timely intervention measures should be taken to reduce the risk of traumatic arthritis after operation.

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Section: Discussionmentioning

confidence: 99%

Logistic Regression Analysis of Risk Factors and Improvement of Clinical Treatment of Traumatic Arthritis after Total Hip Arthroplasty (THA) in the Treatment of Acetabular Fractures

Zhang

Feng²

2022

Computational and Mathematical Methods in Medicine

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“…In several reports, the success rate of CD was greatly reduced, and the THA conversion rate was increased in ONFH with large necrotic lesions [ 34 , 35 ]. Because varying rates of success have been reported depending on the study sample size, follow-up period, and type of augmentation [ 36 ], the efficacy of MD remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Multiple Drilling with Recombinant Human Bone Morphogenetic Protein-2 in Korean Patients with Non-Traumatic Osteonecrosis of the Femoral Head: A Prospective Randomized Pilot Study with a Minimum Two-Year Follow-Up

Park

Cho

Kwon

et al. 2022

JCM

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We sought to determine whether multiple drilling (MD) combined with the injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) and β-tricalcium phosphate (β-TCP) could improve survival of the femoral head in pre-collapse lesions of non-traumatic osteonecrosis of the femoral head (ONFH) as compared with MD alone. We conducted a single-site, off-label, comparative and prospective cohort study between November 2017 and May 2019. We enrolled 25 hips (25 patients) with non-traumatic ONFH (Ficat–Arlet stage 2A or less). We performed a survival analysis, and the primary outcome was the occurrence of femoral head collapse on follow-up radiograph. Our cohort consisted of 11 men and 9 women of age 52.5 ± 8.8 years and a body mass index of 24.3 ± 3.0 kg/m2. The femoral heads were preserved in 9 hips (45.0%) and collapsed in 11 hips (55.0%) at the final follow-up; mean survival to collapse was 6.9 (range 2.8–13.5) months. There were no significant differences in the survival of the femoral head between the MD alone group and the MD with rhBMP-2 and β-TCP group (five hips survived, 50% vs. four hips survived, 40%, respectively; p = 0.83). MD combined with the injection of rhBMP-2 and β-TCP did not improve femoral head survival compared to MD alone in the pre-collapse non-traumatic ONFH lesion.

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“…In addition, some studies report that CD can only exert a short-term therapeutic effect and the long-term curative effect is poor and does not preclude the need for total hip replacement (73)(74)(75)(76). Multiple drilling cannot effectively reduce the rate of THA conversion in early-stage NONFH.…”

Section: Hyperbaric Oxygen Therapy (Hbo)mentioning

confidence: 99%

“…Multiple drilling cannot effectively reduce the rate of THA conversion in early-stage NONFH. In fact, the risk of conversion to THA is increased after multiple drilling in case of larger necrotic lesions, presence of bone marrow edema and higher postoperative workload ( 74 , 75 ). Furthermore, Sadile et al ( 76 ) report lower efficacy of CD against NONFH compared with that of other palliative surgical techniques in terms of clinical status, imaging characteristics and the need for total hip replacement.…”

Section: Treatment Strategiesmentioning

confidence: 99%

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

et al. 2022

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Non-traumatic osteonecrosis of the femoral head is the main cause of disability in young individuals and incurs major health care expenditure. The lifestyle changes in recent years, especially increased use of hormones and alcohol consumption, has greatly increased the incidence of femoral head necrosis. The underlying causes and risk factors of osteonecrosis of the femoral head are increasingly being elucidated, which has led to the development of novel surgical and non-surgical treatment options. Although the main goal of any treatment method is prevention and delaying the progression of disease, there is no common consensus on the most suitable method of treatment. The present review discussed the latest developments in the etiology and treatment methods for femoral head necrosis. Contents 1. Introduction 2. Epidemiology 3. Pathogenesis 4. Treatment strategies 5. Conclusion

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Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course

Cited by 5 publications

References 45 publications

Logistic Regression Analysis of Risk Factors and Improvement of Clinical Treatment of Traumatic Arthritis after Total Hip Arthroplasty (THA) in the Treatment of Acetabular Fractures

Logistic Regression Analysis of Risk Factors and Improvement of Clinical Treatment of Traumatic Arthritis after Total Hip Arthroplasty (THA) in the Treatment of Acetabular Fractures

Multiple Drilling with Recombinant Human Bone Morphogenetic Protein-2 in Korean Patients with Non-Traumatic Osteonecrosis of the Femoral Head: A Prospective Randomized Pilot Study with a Minimum Two-Year Follow-Up

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

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