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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

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Abstract

Introduction

The aim of the study was to assess the factors influencing the final results of treatment of the femoral head osteonecrosis (ONFH) with core decompression and bone substitute grafting. The special interest was focused on comparison between alcohol- and steroid-induced ONFHs.

Material and methods

In this prospective study, a total of 53 patients (58 hips) in the mean age of 35.5 years were included: 29 had a history of alcohol use (32 hips) and 24 of steroid use (26 hips). The mean follow-up was 4.2 years (minimum 3 years).

Results

At last follow-up, significant improvements were noted in the Harris Hip Score (HHS) (mean 44.0 vs 55.9 points, p < 0.00002) and VAS scores (mean 7.0 vs 5.8 points, p < 0.0002) for the whole ONFH cohort, comparing to pre-operative status. The degree of improvement did not differ between Ficat and Arlet grade II and grade III (mean 14.9 vs 6.2 points, respectively, p = 0.1). No change was found between the final and initial results in this group in the steroid group (HHS mean 42.2 vs 45.5 points, p = 0.5 and VAS mean 6.8 vs 6.5 points, p = 0.5), but the improvement was noted in the alcohol group (HHS mean 45.5 vs 64.4 points, p < 0.0001; VAS mean 7.1 vs 5.2 points, p < 0.0001) comparing to pre-operative status.

Conclusions

Presented treatment of ONFH significantly improves hip function, offers pain reduction, and gives similar functional improvement for hips scoring grade II and III on the Ficat and Arlet scale. A good response to operative treatment is seen in patients with alcohol-induced ONFH, but not in those with steroid-induced ONFH.

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Authors and Affiliations

  1. Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland

    Andrzej Sionek, Adam Czwojdziński, Marcin Złotorowicz & Jarosław Czubak

  2. Orthopaedic Department, Medical Centre of Postgraduate Education, Warsaw-Otwock, ul. Konarskiego 13, 05-400, Otwock, Poland

    Jacek Kowalczewski, Tomasz Okoń & Dariusz Marczak

  3. Department of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, ul. Pomorska 251, 92-213, Łódź, Poland

    Marcin Sibiński

Authors
  1. Andrzej Sionek
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  2. Adam Czwojdziński
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  4. Tomasz Okoń
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  5. Dariusz Marczak
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  6. Marcin Sibiński
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  7. Marcin Złotorowicz
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  8. Jarosław Czubak
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Corresponding author

Correspondence to Marcin Sibiński.

Ethics declarations

This study was approved by the ethical committee of our institution. Informed consent was obtained from patients for participation in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Sionek, A., Czwojdziński, A., Kowalczewski, J. et al. 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. International Orthopaedics (SICOT) 42, 1491–1498 (2018). https://doi.org/10.1007/s00264-018-3892-0

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  • DOI: https://doi.org/10.1007/s00264-018-3892-0

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