Non-traumatic necrosis of the femoral head treated with tibial bone-grafting. A follow-up note.

Smith, Koert; Bonfiglio, Michael; Montgomery, William J.

doi:10.2106/00004623-198062050-00028

Cited by 75 publications

(26 citation statements)

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“…After a mean follow-up of approximately 6 years (range, 2 to 17 years), they found satisfactory results in 79 % of hips. However, this same cohort was evaluated by Smith et al [11] after a mean follow-up of 14 years (range, 4 to 27 years), and they noted that of those not deceased or lost to follow-up, only 16 hips (57 %) had satisfactory outcomes.…”

Section: Phemister Techniquementioning

confidence: 96%

A current review of non-vascularized bone grafting in osteonecrosis of the femoral head

Pierce

Elmallah

Jauregui

et al. 2015

Curr Rev Musculoskelet Med

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Over the past three decades, non-vascularized bone grafts have been demonstrated to be viable treatments for preand early post-collapse osteonecrosis of the femoral head; however, there are limited reviews on this topic. Therefore, the purposes of this review are to (1) provide a summary of the different surgical techniques and their respective clinical outcomes and (2) evaluate new adjunct therapies. Originally, nonvascularized bone grafting was performed using the Phemister technique with varying results. More recently, newer techniques such as the lightbulb and trapdoor are used to place non-vascularized bone grafts with excellent results. The addition of various biological agents has demonstrated positive results; however, further studies are needed to confirm the best appropriate indications and to elucidate long-term results.

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Section: Phemister Techniquementioning

confidence: 96%

A current review of non-vascularized bone grafting in osteonecrosis of the femoral head

Pierce

Elmallah

Jauregui

et al. 2015

Curr Rev Musculoskelet Med

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“…The purpose of hip-preserving surgery is intended to maximally preserve and improve hip function by mending and reconstructing the blood supply, strengthening braced force of the subchondral bone of femoral head, and promoting repair and reconstruction of the necrotic bone. There exist multiple hip-preserving operative approaches, such as osteotomy [10], medullary core decompression surgery [11][12][13], fibular support surgery [14][15][16], and vascularized or non-vascularized bone flap grafting surgery [17,18], etc. However, the definite clinical efficacy of all the above approaches is full of controversy.…”

Section: Introductionmentioning

confidence: 99%

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

Zeng

He²,

Feng³

et al. 2013

International Orthopaedics (SICOT)

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Purpose To investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by grafting a vascularized greater trochanter flap combined with a free iliac flap, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH without total hip arthroplasty (THA) surgery. Method Our research included a total of 60 patients (66 hips) who accepted hip-preserving surgery by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering because of ONFH (most were Association Research Circulation Osseous (ARCO) stage III patients) from January, 2006 to December, 2010. A Harris Hip Score was obtained during follow-ups, evaluating the clinical efficacy, X-rays were taken regularly for image assessing, and the SF-36 scale was used for estimating quality of life. Terminal observation time was considered when patients had symptom-dependant indications for performing another hip-preserving surgery or THA surgery. Results Fifty-eight patients (64 hips) were eventually contacted by telephone for an out-patient clinic return visit, with a mean follow-up time of 35.8 months (varied from 12 months to 60 months), but two patients lost contact for various reasons. The demographic data were as follows: there were 16 ARCO IIIA cases, 22 ARCO IIIB cases, and 26 ARCO IIIC cases, respectively. Postoperative X-rays revealed a well-repaired necrotic area of the femoral head and improvement of femoral-acetabulum coverage. The last follow-up mean Harris Hip Score was 86.56±7.38 (excellent results reached 87.50 %), which were greatly improved compared to 50.95±6.86 pre-operatively. Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) scores were enhanced from 42± 13 pre-operatively to 78±11, while the postoperative mental component summary (MCS) scores (76±11) largely increased in contrast to pre-operative scores (51±10), with both target indices having statistical significance (p=0.005, p=0.01), signifying hugely improvement of the quality of life of the patients. A correlation was found between Harris Hip Score and all dimensions of SF-36 scale (r=0.32-0.72), especially closely correlated with physical functioning (PF), role-physical (RP) and bodily pain (BP) in PCS aspect (r= 0.72, p < 0.01; r = 0.58, p < 0.01; r = 0.65, p < 0.01, respectively). Conclusion There is definite curative efficacy for the treatment of ONFH with an hip-preserving operative approach by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering. This kind of operative approach reconstructs the biological stability of femoral head, which promotes repair of necrotic areas and indirectly preserves the femoral head of patients and a majority of hip function. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundam...

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“…The scores for pain and gait were then doubled and added to the movement score to give an overall value between 5-30 according to the method of Willert [26]. The clinical result of each operation was classified according to the final score achieved as, very good (28-30), good (25)(26)(27), acceptable (22)(23)(24) or bad (21 or less). The patients' opinions of their result were recorded as "unsatisfactory", "satisfactory" or "very satisfactory".…”

Section: Assessment Of Clinical Resultsmentioning

confidence: 99%

“…A number of methods of treatment for idiopathic necrosis of the head of the femur, based on the characteristics of the lesion, have been reported previously [4,5,6,8,11,12,14,16,17,18,20,22]. However, the choice of treatment for relatively young patients presenting with intermediate grade disease is still uncertain.…”

Section: Introductionmentioning

confidence: 99%

The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur

Cañadell

Aguilella

Azcárate

et al. 1986

International Orthopaedics

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SUMMARYThe authors present their experience of the use of intertrochanteric osteotomy for the treatment of idiopathic necrosis of the head of the femur. The results obtained from 102 osteotomies performed on 81 patients with the disease are analysed. The mean followup is 4.2 years. The results show a statistically significant clinical improvement after operation. Patients presenting with Ficat and Arlet Stage II involvement fared much better than those with more severe changes. Better results were also seen in those with a necrosis angle of less than 200°. No radiological improvement was seen although a high percentage showed no deterioration. The choice of treatment for the condition is discussed in the light of these results.

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Non-traumatic necrosis of the femoral head treated with tibial bone-grafting. A follow-up note.

Cited by 75 publications

References 0 publications

A current review of non-vascularized bone grafting in osteonecrosis of the femoral head

A current review of non-vascularized bone grafting in osteonecrosis of the femoral head

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head

The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur

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