The use of non-vascularized bone grafts to treat osteonecrosis of the femoral head: indications, techniques, and outcomes

Abstract

Osteonecrosis of the femoral head (ONFH) is a multi-factorial disease with relatively unknown aetiology and unclear pathogenetic mechanism. Left untreated, the natural history of the disease is progressive collapse of the femoral head and destruction of the joint with substantial pain and disability. The disease primarily affects younger individuals, in whom many surgeons will typically prefer to delay performing total hip arthroplasty (THA). Therefore, increasing attention has been given to a wide variety of femoral head-preserving procedures. The use of non-vascularized bone grafting (NVBG) to treat ONFH has mainly been advocated for pre-collapse and select, early post-collapse lesions. Currently, multiple studies reported on various non-vascularized bone grafting techniques of treating ONFH. Clinical outcomes have varied widely, with success rates reported between 55 and 87% in the short- to mid-term, with long-term results lacking. Due to the current paucity of studies, in this review we aimed to discuss (1) indications, (2) techniques, and (3) outcomes of non-vascularized bone grafting used to treat osteonecrosis of the femoral head.

WITHDRAWN: High Failure Rate after Beta-tricalcium Phosphate Grafting for the Treatment of Femoral Head Osteonecrosis: a Retrospective Analysis

“…The impaired blood supply to the femoral head results in cellular apoptosis, subchondral fracture, and collapse at a later stage, subsequently deteriorate disabled osteoarthritis. Most authors believe that effective intervention at an early stage can successfully protect these hips from collapse [19,20]. The "light-bulb" technique obtains outstanding clinical efficacy, at a mean follow-up of 12 years, showing success in 84.6% (11) of 13 hips [10].…”

WITHDRAWN: High Failure Rate after Beta-tricalcium Phosphate Grafting for the Treatment of Femoral Head Osteonecrosis: a Retrospective Analysis

“…Necrotic lesions of the femoral head were graded according to the Association Research Circulation Osseous (ARCO) stage [16]. Patients who presented with NONFH in ARCO stage Ⅱ or Ⅲa were included for the proposed procedure [17], and exclusion criteria were: (1) over-aged, mainly above 50 years; (2) unable to stop corticosteroids administration due to corticosteroid-dependent diseases; (3) failed to quit alcohol abuse. Patients who were in ARCO stage Ⅳ or in ARCO stage Ⅲb and Ⅲc with complaints of serious pain were included for THA [18].…”

Femoral Head and Neck Fenestration Through a Direct Anterior Approach Combined With Compacted Autograft for the Treatment of Early Stage Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Study

“…The long-term success rate of vascularized bone grafting is variable because of the complex technology, long operation time, and large trauma [30]. Therefore, many orthopedic surgeons have introduced various nonvascularized bone grafting techniques, such as the light bulb technique [31,32].…”