Artikel
Long term follow-up of phemister bone grafting for patients with non-traumatic osteonecrosis of femoral head
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Veröffentlicht: | 23. Oktober 2017 |
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Objectives: Osteonecrosis of the femoral head (ONFH) is debilitating disease that affects the hips of young adults. Total hip arthroplasty (THA) is often required if effective treatment methods are not adopted in the early stage to defer disease progression. Clinical and experimental studies by Phemister and Bonfiglio on the treatment of ONFH have described the technique of core decompression and insertion of two strut bone grafts as an efficacious measurement for early-stage ONFH. The purpose of this study was to investigate the survivorship and risk factors for radiographic progression and conversion to THA after Phemister procedure.
Methods: From 1994 to 2010, we treated 31 hips in 26 patients with pre-collapsed or early-collapsed (< 2mm) ONFH by Phemister procedure (core decompression and insertion of 2 strut fibular allografts). A total of 29 hips were available for evaluation of which 9 were ARCO stage IIA, 13 stage IIB, 4 stage IIC, and 3 stage IIIA. The patients were 24~58 years of age (mean, 38.9 years). The mean follow-up was 13 years. Demographic data, Harris hip score (HHS), and radiographic parameters were reviewed. Survivorship was analyzed with conversion to THA as the endpoint.
Results and Conclusion: ResultsA total of 10 hips underwent THA at a mean of 10 years (SD 6.1). The overall clinical successful rate for hip preserving was 65.5%, and radiological successful rate without further collapse or progression was 31% after a mean follow-up of 13 years. The mean HHS improved from 50.3 (SD 7.8) to 76.1 (SD 13.3). The survival time of hips analyzed by Kaplan-Meier curves was significantly shorter with male patients (P < 0.01), ARCO stage III disease (P = 0.03), a lateral lesion (P < 0.01), and a necrotic index equal or more than 0.6 (P < 0.01). The Cox proportional hazards model showed that gender, ARCO stage and necrotic index were independent risk factors for conversion to THA, while age and the location of lesion were independent risk factors for radiological progression.
Conclusions Phemister procedure is technically simpler and more appealing than vascularized fibular bone graft. It provides decompression of the lesion and support of the subchondral bone. In our study, this technique has shown acceptable long-term outcomes without serious complications, especially for lesions with earlier stage and smaller necrotic index. As a head-preserving procedure, Phemister technique is worthwhile for young patients to postpone the need for THA.