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Long-term results of decompression and muscle-pedicle bone grafting for osteonecrosis of the femoral head

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Abstract

In this paper, 152 patients with 187 osteonecrotic femoral heads (83 idiopathic, 56 corticosteroid induced, 40 post-traumatic, seven alcohol abuse and one associated with gout) were classified according to the staging by Ficat and Arlet (Ischemia and necroses of bone, Williams and Wilkins, Baltimore, Maryland, pp 171–182, 1980); four were in Stage I, 82 in Stage II and 101 in Stage III. The majority of the patients were young (average age 35.5 years). Multiple drilling, curettage of the necrotic bone and muscle-pedicle bone grafting using tensor fascia lata was carried out in all patients except in six adolescents, where sartorius grafting was performed. Cheilectomy of the femoral head and subcutaneous adductor tenotomy were also performed in the advanced stages. During the follow up of 10 to 21.5 years (average 16.5 years), radiological improvement was noted in 81.3% of patients in Stage II and 70.1% of patients in Stage III cases. Excellent and good results according to the Hospital for Special Surgery (HSS) score were obtained in 100% of cases in Stage I, 92% in Stage II and 80.4% in stage III, with a survivorship of 91% in Stage II and 82% in Stage III cases. The patients having an HSS score below 20 (non-survival) were recommended for total hip replacement (THR) therapy.

Résumé

152 patients présentant 187 nécroses de la tête fémorale (83 idopathiques, 56 après corticoïdes, 40 post-traumatiques, 7 d’origine éthyliques et une associée à une goutte) ont été traités. Selon les classifications de Ficat et Arlet, 4 étaient au stade I, 82 au stade II et 101 au stade III. La majorité des patients étaient jeunes (35,5 ans). Forage et curetage de la nécrose et greffe pédiculaire ont été réalisés chez 6 adolescents. Cheilectomie et ténotomie percutanées des adducteurs ont été également réalisées. Le suivi moyen a été de 16.5 ans (10 à 21.5 ans). Il n’y a pas d’altération radiographique chez les patients de stade I. Une amélioration a été notée dans 81.3% des patients de stade II et 70.1% des patients de stade III. De bons résultats cliniques ont été mis en évidence (score de Salvati et Wilson) dans 100% des patients de stade I, 92% au stade II et 80.4% au stade III avec un taux de survie de 91% au stade II, et 82% de stade III. Les patients présentant une aggravation de la nécrose avec un score en dessous de 20 ont été considérés comme devant bénéficier d’une prothèse totale.

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Acknowledgement

We are grateful to Dr. Saurabh Ghosh, Assistant Professor, Applied Statistics Unit, Indian Statistical Institute, Kolkata, India, for his kind help in the statistical analysis of the survivorship data.

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Authors and Affiliations

  1. DA-3, Sector I, Salt Lake City, Kolkata, 700064, India

    Durgapada P. Baksi

  2. Department of Orthopaedics, Burdwan Medical College, Burdwan, India

    Ananda Kisor Pal

  3. Department of Orthopaedics, Institute of Postgraduate and Medical Education & Research, Kolkata, India

    Debadyuti D. Baksi

  4. Department of Orthopaedics, Medical College and Hospital, 72 College Street, Kolkata, 700014, India

    Durgapada P. Baksi

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  1. Durgapada P. Baksi
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  2. Ananda Kisor Pal
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Correspondence to Durgapada P. Baksi.

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Baksi, D.P., Pal, A.K. & Baksi, D.D. Long-term results of decompression and muscle-pedicle bone grafting for osteonecrosis of the femoral head. International Orthopaedics (SICO 33, 41–47 (2009). https://doi.org/10.1007/s00264-007-0455-1

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  • DOI: https://doi.org/10.1007/s00264-007-0455-1

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