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Comparison of the outcome of different bone grafts combined with modified core decompression for the treatment of ARCO II stage femoral head necrosis

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Abstract 

Purpose

Treatment of ONFH at an early stage is a challenging issue. The modified minimally invasive core decompression combined with bone graft implantation remains controversial. This study aimed to compare the early-middle outcomes of four groups with different bone grafts.

Methods

A total of 182 patients (192 hips) with ONFH at the ARCO II stage were randomly divided into four groups. The free fibular graft group (FFG), free vascularized fibular graft group (FVFG), autologous iliac bone group (ABG), and β-tricalcium bioceramics phosphate graft (β-TCPG) group. Each group was treated with the modified minimally invasive core decompression and bone graft implantation. The operation time and blood loss were recorded by the same observer. The clinical outcome was evaluated by the Harris Hip Score and VAS score (before, 14 days after surgery, and at the last follow-up). The radiographic progression of ONFH was evaluated at least 36 months of follow-up.

Results

All cases were successful without any complications after the operation. The patients were followed up for 42 to 48 (44.62 ± 1.81) months. There were statistically significant differences among the four groups in operation time (F value = 1520.67; P < 0.01) and blood loss (F value = 5366.81; P < 0.01). The Harris Hip Score in each group was improved significantly from pre-operation to last follow-up (all P < 0.01). At the last follow-up, the difference in the Harris Hip Score in each group was not statistically significant (F value = 0.54; P = 0.984). The VAS scores in each group were decreased significantly from the pre-operation to14 days after surgery (all P < 0.01). At 14 days after surgery, the difference in the VAS score in each group was not statistically significant (F value = 0.64; P = 0.59). At the last follow-up, three hips collapsed on the femoral head in the FFG group, two in the FVFG group, two in the ABG group, and three in the β-TCPG group.

Conclusion

The four different bone graft implantation showed satisfactory early-middle outcomes. As compared to other bone grafts, the β-TCP bioceramics graft has the advantages of shorter operation time and lesser blood loss. It may be a choice as a bone graft for the treatment of ONFH at an early stage.

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Data availability

This manuscript has no associated data or the data will not be deposited.

References

  1. Microsurgery Department of the Orthopedics Branch of the Chinese Medical Doctor Association; Group from the Osteonecrosis and Bone Defect Branch of the Chinese Association of Reparative and Reconstructive Surgery; Microsurgery and Reconstructive Surgery Group of the Orthopedics Branch of the Chinese Medical Association (2017) Chinese Guideline for the Diagnosis and Treatment of Osteonecrosis of the Femoral Head in Adults. Orthop Surg 9(1):3–12. https://doi.org/10.1111/os.12302

    Article  Google Scholar 

  2. Lin D, Wang L, Yu Z, Luo D, Zhang X, Lian K (2018) Lantern-shaped screw loaded with autologous bone for treating osteonecrosis of the femoral head. BMC Musculoskelet Disord 19(1):318. https://doi.org/10.1186/s12891-018-2243-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Larson E, Jones LC, Goodman SB, Koo KH, Cui Q (2018) Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018? Int Orthop 42(7):1723–1728. https://doi.org/10.1007/s00264-018-3917-8

    Article  PubMed  Google Scholar 

  4. Arbeloa-Gutierrez L, Dean CS, Chahla J, Pascual-Garrido C (2016) Core decompression augmented with autologous bone marrow aspiration concentrate for early avascular necrosis of the femoral head. Arthrosc Tech 5(3):e615–e620. https://doi.org/10.1016/j.eats.2016.02.009

    Article  PubMed  PubMed Central  Google Scholar 

  5. Civinini R, Capone A, Carulli C, Matassi F, Nistri L, Innocenti M (2017) The kinetics of remodeling of a calcium sulfate/calcium phosphate bioceramic. J Mater Sci Mater Med 28(9):137. https://doi.org/10.1007/s10856-017-5940-5

    Article  CAS  PubMed  Google Scholar 

  6. Etter S, Faivre A, Solignac P, Clément S, Fromental J-M, Duffour L et al (2015) Stress corrosion and droplets formation in calcium phosphate and calcium alumino-phosphate glasses. J Mater Sci 50(21):7010–7017. https://doi.org/10.1007/s10853-015-9253-0

    Article  CAS  Google Scholar 

  7. Lai Y, Li Y, Cao H, Long J, Wang X, Li L et al (2019) Osteogenic magnesium incorporated into PLGA/TCP porous scaffold by 3D printing for repairing challenging bone defect. Biomaterials 197:207–219. https://doi.org/10.1016/j.biomaterials.2019.01.013

    Article  CAS  PubMed  Google Scholar 

  8. Lai Y, Cao H, Wang X, Chen S, Zhang M, Wang N et al (2018) Porous composite scaffold incorporating osteogenic phytomolecule icariin for promoting skeletal regeneration in challenging osteonecrotic bone in rabbits. Biomaterials 153:1–13. https://doi.org/10.1016/j.biomaterials.2017.10.025

    Article  CAS  PubMed  Google Scholar 

  9. Maruyama M, Pan CC, Moeinzadeh S, Storaci HW, Guzman RA, Lui E et al (2021) Effect of porosity of a functionally-graded scaffold for the treatment of corticosteroid-associated osteonecrosis of the femoral head in rabbits. J Orthop Translat 28:90–99. https://doi.org/10.1016/j.jot.2021.01.002

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhang L, Zhang J, Liang D, Ling H, Zhang Y, Liu Y et al (2021) Clinical study on minimally invasive treatment of femoral head necrosis with two different bone graft materials. Int Orthop 45(3):585–591. https://doi.org/10.1007/s00264-020-04916-z

    Article  PubMed  Google Scholar 

  11. Xie XH, Wang XL, Yang HL, Zhao DW, Qin L (2015) Steroid-associated osteonecrosis: epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview). J Orthop Translat 3(2):58–70. https://doi.org/10.1016/j.jot.2014.12.002

    Article  PubMed  PubMed Central  Google Scholar 

  12. Auregan JC, Villain B, Begue T (2018) What is the rate of patients undergoing a total hip arthroplasty after core decompression and insertion of a tantalum rod in osteonecrosis of the femoral head: a systematic review. Int Orthop 42(7):1631–1638. https://doi.org/10.1007/s00264-018-3961-4

    Article  PubMed  Google Scholar 

  13. D’Ambrosi R, Biancardi E, Massari G, Ragone V, Facchini RM (2018) Survival analysis after core decompression in association with platelet-rich plasma, mesenchymal stem cells, and synthetic bone graft in patients with osteonecrosis of the femoral head. Joints 6(1):16–22. https://doi.org/10.1055/s-0038-1626740

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cao L, Guo C, Chen J, Chen Z, Yan Z (2017) Free vascularized fibular grafting improves vascularity compared with core decompression in femoral head osteonecrosis: a randomized clinical trial. Clin Orthop Relat Res 475(9):2230–2240. https://doi.org/10.1007/s11999-017-5374-x

    Article  PubMed  PubMed Central  Google Scholar 

  15. Liu L, Gao F, Sun W, Wang Y, Zhang Q, Wang B et al (2018) Investigating clinical failure of core decompression with autologous bone marrow mononuclear cells grafting for the treatment of non-traumatic osteonecrosis of the femoral head. Int Orthop 42(7):1575–1583. https://doi.org/10.1007/s00264-018-3918-7

    Article  PubMed  Google Scholar 

  16. Sallam AA, Imam MA, Salama KS, Mohamed OA (2018) Inverted femoral head graft versus standard core decompression in nontraumatic hip osteonecrosis at minimum 3 years follow-up. Hip Int 27(1):74–81. https://doi.org/10.5301/hipint.5000426

    Article  Google Scholar 

  17. Andriolo L, Merli G, Tobar C, Altamura SA, Kon E, Filardo G (2018) Regenerative therapies increase survivorship of avascular necrosis of the femoral head: a systematic review and meta-analysis. Int Orthop 42(7):1689–1704. https://doi.org/10.1007/s00264-018-3787-0

    Article  PubMed  Google Scholar 

  18. Landgraeber S, Warwas S, Classen T, Jager M (2017) Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head. BMC Musculoskelet Disord 18(1):479. https://doi.org/10.1186/s12891-017-1811-y

    Article  PubMed  PubMed Central  Google Scholar 

  19. Li B, Lei P, Liu H, Tian X, Wen T, Hu R et al (2018) Clinical value of 3D printing guide plate in core decompression plus porous bioceramics rod placement for the treatment of early osteonecrosis of the femoral head. J Orthop Surg Res 13(1):130. https://doi.org/10.1186/s13018-018-0812-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Sionek A, Czwojdzinski A, Kowalczewski J, Okon T, Marczak D, Sibinski M et al (2018) Hip osteonecroses treated with calcium sulfate-calcium phosphate bone graft substitute have different results according to the cause of osteonecrosis: alcohol abuse or corticosteroid-induced. Int Orthop 42(7):1491–1498. https://doi.org/10.1007/s00264-018-3892-0

    Article  PubMed  Google Scholar 

  21. Wang G, Li Y, Sun T, Wang C, Qiao L, Wang Y et al (2019) BMSC affinity peptide-functionalized beta-tricalcium phosphate scaffolds promoting repair of osteonecrosis of the femoral head. J Orthop Surg Res 14(1):204. https://doi.org/10.1186/s13018-019-1243-5

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This research was supported by the Zhejiang Provincial Natural Science Foundation of China under Grant No. LQ20H170001; the Joint Funds of the Zhejiang Provincial Natural Science Foundation of China under Grant No.LBY21H170001; and basic research project of Shenzhen Science and Technology Innovation Commission under Grant No. JCYJ20210324122807021.

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Authors

Contributions

Junming Wan and Yanqing Hu designed the study. Junming Wan, Yanqing Hu, Yuqing Zeng, and Haiyong Ren performed the operation. Jiachun Li analyzed the results. All authors participated in writing the manuscript.

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Correspondence to Junming Wan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (the Institutional Review Board of Sun Yet-sun University (No.SYSU-2020125) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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All patients informed consent to participate in this study.

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The authors declare no competing interests.

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Wan, J., Hu, Y., Li, J. et al. Comparison of the outcome of different bone grafts combined with modified core decompression for the treatment of ARCO II stage femoral head necrosis. International Orthopaedics (SICOT) 46, 1955–1962 (2022). https://doi.org/10.1007/s00264-022-05418-w

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  • DOI: https://doi.org/10.1007/s00264-022-05418-w

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