Porous tantalum rods for treating osteonecrosis of the femoral head

Abstract

ABSTRACT. This study evaluated the outcomes of using porous tantalum rods for the treatment of osteonecrosis of the femoral head (ONFH). We performed core decompression and inserted porous tantalum implants in 149 patients (168 consecutive hips) with ONFH. Hips had large (65), medium (64), or small (39) lesions; 63 lesions were lateral, 68 were central, and 35 were medial. Conversion to total hip arthroplasty (THA) was the end point of this survey. A total of 130 cases (138 hips) were followed. The mean follow-up time was 38.46 ± 5.76 months; 43 hips (31%) were converted to or needed THA. Of the 43 hips requiring THA, 33 had large lesions, including 1 medial, 3 central, and 29 lateral lesions; 9 had medium, lateral lesions, and 1 hip had a small, lateral lesion. Bone grafting was used in 59 hips, with 3 hips failing; 40 of 79 hips without bone grafts failed. The sum distances between the tops of the rods and the lateral lesion boundaries (SDTL, mm) were measured in anteroposterior and lateral radiographs. In the failure and spared groups, the average SDTLs were 7.65 ± 2.759 and 0.83 ± 2.286 mm, respectively. The survival of porous tantalum rods used for treating early-stage ONFH was affected by the size and location of the lesion, whether or not a 8343 ©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 13 (4): 8342-8352 (2014) Porous tantalum rods for treating osteonecrosis bone graft was used, as well as the distance between top of the rod and the lateral boundary of the lesion.

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

“…It has been combined with arthroscopy [176][177][178]198,199 , tantalum rods 175,185,186,188,190,[200][201][202] , calcium bonegraft substitutes 172,182,184 , platelet-rich plasma 177 , cell-based therapies, and adjunctive therapies (bisphosphonates, ESWT, iloprost, etc.) 168,189,191,194,203 .…”

“…Arthroscopy-assisted decompression may help to evaluate articular cartilage, degree of collapse, and labral pathology and may provide reaming guidance 178 . Tantalum rods and bone-graft substitutes have varying success rates (44% to 100%) 114,186,188,190 , and lack substantive evidence. In a series of 138 hips treated with tantalum rods, forty-three (31%) …”

“…required total hip arthroplasty at a mean follow-up of four years 186 . Some authors have suggested that revision to total hip arthroplasty can result in increased bleeding and leave remnant metal particles, while arthroscopy adds an additional surgery with little added benefit unless there is soft-tissue pathology 178,185,198,200,204 .…”

A current review of core decompression in the treatment of osteonecrosis of the femoral head

“…There have been attempts to use various adjunctive therapies with this procedure such as the following: (1) bone grafting [13,23,26]; (2) addition of mesenchymal cells [13,23,26]; and (3) tantalum rod insertion [9,11,[36][37][38][39][40][41].…”

“…In addition, another commonly used technique involves multiple percutaneous drillings [5,6]. Techniques have been combined with several other adjunctive treatment modalities such as bone grafting and the addition of growth and differentiation factors [7][8][9][10][11][12]. The purpose of this review is to describe the following: (1) how traditional core decompression is performed, (2) adjunctive treatments, (3) multiple percutaneous drilling, and (4) the overall outcomes of this procedures.…”