Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head

Matsusaki, Hiroshi; Noguchi, Masataka; Kawakami, Toru; Tani, Tohru

doi:10.1007/s00402-004-0777-z

Cited by 32 publications

(25 citation statements)

References 10 publications

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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%

“…A meta-analysis [23] manifested that further surgery was indicated for those who suffered Steinberg stages I, II, and III of ONFH when performing medullary core decompression (16 %, 37 %, and 71 %, respectively). Patients in Ficat II and III stage of ONFH frequently acquired satisfactory outcomes by grafting vascularized bone flaps [17,18].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

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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“…These results are comparable to those reported in the literature. [15][16][17][18] There is still no agreement on the best surgical method for ANFH yet. Conceptually, the best option is removal of the necrotic bone from the femoral head and replacement with a viable and structurally-sound bone, thus restoring vitality to the femoral head, preventing collapse of the articular surface, and delaying, THA, if prevention is unlikely.…”

Section: Discussionmentioning

confidence: 99%

“…Several head preserving procedures such as core decompresion, osteotomies and non-vascularized or vascularized bone grafting have been used to avert the need for total hip replacement. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The vascularized fibular grafting is associated with better clinical and radiographic results than non-vascularized fibular grafting in precollapse hips. [9][10][11][12] The rationale of vascular pedicled fibula grafting procedure is based on the following points: decompression of the femoral head diminishes intraosseous pressure like compartment syndrome and improves the interrupted circulation which contributes the disease progression.…”

mentioning

confidence: 99%

Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis

Elmalı¹

2014

Eklem Hastalik Cerrahisi

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82.8'e (dağılım; 62-90) yükseldi. Klinik sonuçlar 18 kalçada (%69) iyi ve mükemmel iken, sekiz kalçada (%31) yeterli ve kötü idi. ARCO evreleme sistemine göre, 26 kalçanın 17'sinde (%65) tatminkar sonuç sağlandı. Ameliyat öncesi evre II olan dört kalçadan ikisi evre III'e, ikisi evre IV'e ilerledi. Ameliyat öncesi evre III olan beş kalça evre IV'e ilerledi ve bu hastalara total kalça artroplastisi uygulandı. Sonuç: Çalışma bulgularımız, kor dekompresyon ve damar pediküllü iliyak kemik greft uygulamasının erken evre FBAN'nin tedavisinde etkili olduğunu göstermektedir. The main predisposing factor was steroid use in 13 patients. All patients were assessed clinically according to the Harris hip score and by radiographs by the Association Internationale de Recherche sur la Circulation Osseuse (ARCO) staging system. Results: The mean follow-up was 36 (range 14 to 62) months. Eleven hips (42%) had stage II and 15 hips (58%) had stage III ANFH. The mean Harris scores increased from 52 (range 31 to 63) to 82.8 (range 62 to 90) after surgery. Based on clinical outcomes, 18 hips (69%) were presented as excellent and good, while eight hips presented fair and poor. According to the ARCO staging system, satisfactory results were provided in 17 (65%) of the 26 hips. Two of four hips at preoperatively stage II progressed to stage III, two other hips to stage IV. Five hips at stage III preoperatively progressed to stage IV and these hips had to undergo hip replacement. Conclusion: Our results suggest that core decompression and the vascular pedicled iliac bone grafting are effective in early stages of ANFH.

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“…(Fig. 1) 27) , 기존의 대퇴 골두 보존술은 그 결 과가 다양한 점, 술기가 어렵다는 점, 그리고 공여부의 이환 율이 높다는 문제점이 이러한 시도를 뒷받침하고 있다 [15][16][17][18] . 골수 이식술의 효과를 설명할 수 있는 다른 이론은 주입 한 골수 세포가 혈관생성을 촉진하는 사이토카인을 분비함 으로써 결과적으로 혈관 생성을 증가시켜 괴사부분에 골형 성을 유발한다는 것이다 19) .…”

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Mid-term Results of Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

et al. 2014

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Purpose: This study evaluated mid-term clinical and radiological results of autologous bone marrow transplantation (BMT) for early stage osteonecrosis of the femoral head (ONFH) and analyzed prognostic factors. Materials and Methods: From November 2003 to April 2008, 101 hips of 93 patients with early stage ONFH who underwent autologous BMT were followed for at least five years. For clinical results, preoperative and postoperative Harris hip scores (HHS) were evaluated and survival rate was obtained at the point of performing total hip arthroplasty or femoral head collapse progression. Radiologic results were assessed by changes in necrosis size on magnetic resonance imaging performed preoperative and postoperatively. For evaluation of prognostic factors, survival rate was analyzed according to age, gender, etiology, stage, necrosis size, and location. Results: Averaged HHS at latest follow up showed no significant change in comparison with preoperative HHS. Of 101 hips, 35 hips required arthroplasty and six hips were running head collapse. Groups with use of steroid, lateral location of necrosis, large size of necrosis, or large necrotic angles showed lower survival rate. However, age, gender, and stage had no effect. Conclusion: In early days, autologous BMT for early ONFH can be considered as a treatment for improvement of clinical features and delay of radiologic progress. However, after some years, there was no effect compared with the natural course of ONFH.

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Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head

Cited by 32 publications

References 10 publications

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

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

Vascular pedicled iliac bone grafting is effective in patients with an early stage of femoral head avascular necrosis

Mid-term Results of Autologous Bone Marrow Transplantation in Osteonecrosis of the Femoral Head

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