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Clinical Orthopaedics and Related Research

, Volume 466, Issue 5, pp 1125–1132 | Cite as

Nonvascularized Bone Grafting Defers Joint Arthroplasty in Hip Osteonecrosis

  • Thorsten M. Seyler
  • David R. Marker
  • Slif D. Ulrich
  • Tobias Fatscher
  • Michael A. Mont
Symposium: Molecular and Surgical Advances in Osteonecrosis

Abstract

A variety of nonvascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. We retrospectively reviewed 33 patients (39 hips) with osteonecrosis of the hip who had nonvascularized bone grafting procedures with supplemental OP-1. We compared the outcomes in this cohort to similar patients treated nonoperatively or with other nonvascularized bone grafting procedures. We used a trapdoor to make a window at the head-neck junction to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft, marrow, and OP-1. The minimum followup was 24 months (mean, 36 months; range, 24–50 months). We performed no further surgery in 25 of 30 small- and medium-sized lesions (80%) but did in two of nine large lesions. Hips with Ficat Stage II disease were not reoperated in 18 of 22 cases during the followup periods. Our short-term results compare similarly to nonoperative treatment and other reports of nonvascularized bone grafting. With the addition of ancillary growth factors, these procedures effectively reduce donor site morbidity and may defer joint arthroplasty in selected patients.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Femoral Head Osteonecrosis Core Decompression Intertrochanteric Osteotomy Femoral Head Collapse 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Colleen Kazmarek for her assistance in the preparation of this manuscript.

Supplementary material

11999_2008_211_MOESM1_ESM.pdf (13 kb)
ESM1 (PDF 13 kb)
11999_2008_211_MOESM2_ESM.pdf (14 kb)
ESM2 (PDF 14 kb)
11999_2008_211_MOESM3_ESM.tif (683 kb)
The Phemister technique is illustrated with its three key steps. (TIF 699 kb)
11999_2008_211_MOESM4_ESM.tif (468 kb)
The Trapdoor approach is illustrated with its five key steps. (TIF 479 kb)

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Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Thorsten M. Seyler
    • 1
    • 2
  • David R. Marker
    • 1
  • Slif D. Ulrich
    • 1
  • Tobias Fatscher
    • 1
  • Michael A. Mont
    • 1
  1. 1.Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and ReconstructionSinai Hospital of BaltimoreBaltimoreUSA
  2. 2.Department of Orthopaedic SurgeryWake Forest UniversityWinston-SalemUSA

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