Abstract
Osteonecrosis of the femoral head (ONFH) is a disease with a wide-ranging etiology and poorly understood pathogenesis seen commonly in young patients. Various head-preserving procedures have been used to avert the need for total hip replacement. These include vascularized and non-vascularized bone grafting procedures, bone marrow containing osteogenic precursors implanted into the necrotic lesion. We use drills, curettes, broaches under image intensifier to perform a thorough debridement of all necrotic lesion, pack autogenous cortical and cancellous bone which were harvested from the ipsilateral iliac crest tightly into the femoral head, implant bone-marrow mononuclear cells containing mesenchymal stem cells into the necrotic lesion. The study included 15 patients (20 hips, 10 males, 5 females, mean age 35 years, range 23–58 years) with stage II–III ONFH according to the association research circulation osseous classification. The outcome was determined by changes in the Harris hip score (HHS), by progression in radiographic stages, and by the need for hip arthroplasty. The mean follow-up was 24 months (range 9–36 months). The mean HHS increased from 64 to 85 points. The overall clinical success rate is 80 %. There were no infection, femoral neck fracture or other complications. Thorough debridement, autogenous bone grafting and bone-marrow mononuclear cells implantation is an effective procedure in patient with small lesion, early-stage ONFH.
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Abbreviations
- ONFH:
-
Osteonecrosis of the femoral head
- ARCO:
-
Association research circulation osseous
- AP:
-
Anteroposterior
- MRI:
-
Magnetic resonance imaging
- HHS:
-
Harris hip score
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Acknowledgments
Special thanks to Yanping Li, Hui Zhang, Ming Lu, Zheng Jiang, Jun Wang, Jiayong Guo, GongWen Du for their contributions to this work.
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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
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Tao Wang and Wei Wang contributed equally to this work and should be considered as co-first authors.
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Wang, T., Wang, W. & Yin, Z.S. Treatment of osteonecrosis of the femoral head with thorough debridement, bone grafting and bone-marrow mononuclear cells implantation. Eur J Orthop Surg Traumatol 24, 197–202 (2014). https://doi.org/10.1007/s00590-012-1161-2
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DOI: https://doi.org/10.1007/s00590-012-1161-2