Abstract
Background
Phemister procedure is an effective treatment for early stage osteonecrosis of femoral head (ONFH). Since the long-term results of the Phemister procedure are less reported in the literature, the purpose of this study was to investigate the long-term outcomes of this bone grafting technique in patients with earlier stages of ONFH.
Methods
From 1994 to 2010, 29 hips with pre-collapsed or early collapsed (< 2 mm) ONFH treated by Phemister procedure were evaluated. Among them, nine hips were Association Research Circulation Osseous (ARCO) stage IIA, 13 stage IIB, 4 stage IIC, and 3 stage IIIA. The mean age was 38.9 years. The mean follow-up was 14 years (1–21 years). Survivorship was analyzed with conversion to total hip arthroplasty (THA) as the endpoint.
Results
At the final follow-up, 10 hips underwent THA at a mean of ten years (1–18 years). The overall clinical success rate for hip preserving was 65.5%, and radiological success rate was 31%. The mean Harris Hip Score improved from 50.3 to 76.1. The survival of hips was significantly inferior in female patients (P < 0.01), ARCO stage III disease (P = 0.03), lateral type lesion (P < 0.01), and necrotic index ≥ 0.67 (P < 0.01). The Cox proportional hazards model showed that gender, ARCO stage, and necrotic index were independent risk factors for conversion to THA.
Conclusion
The study showed acceptable results without complication in patients receiving Phemister procedure for early stage ONFH at a mean follow-up of 14 years. As a head-preserving procedure, Phemister technique is worthwhile for young patients to postpone the need for THA.
Similar content being viewed by others
References
Ohzono K, Saito M, Takaoka K, Ono K, Saito S, Nishina T, Kadowaki T (1991) Natural history of nontraumatic avascular necrosis of the femoral head. J Bone Joint Surg Br 73(1):68–72
Hungerford DS, Mont MA (1998) The natural history of untreated asymptomatic hips in patients who have non-traumatic osteonecrosis. J Bone Joint Surg Am 80(5):765–766
Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, Hartman KE (2001) Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res 386:71–78
Kerboul M, Thomine J, Postel M, Merle d'Aubigne R (1974) The conservative surgical treatment of idiopathic aseptic necrosis of the femoral head. J Bone Joint Surg Br 56(2):291–296
Wang CJ, Wang FS, Huang CC, Yang KD, Weng LH, Huang HY (2005) Treatment for osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core decompression and bone-grafting. J Bone Joint Surg Am 87(11):2380–2387. https://doi.org/10.2106/jbjs.e.00174
Lee MS, Hsieh PH, Shih CH, Wang CJ (2010) Non-traumatic osteonecrosis of the femoral head—from clinical to bench. Chang Gung Med J 33(4):351–360
Pierce TP, Elmallah RK, Jauregui JJ, Poola S, Mont MA, Delanois RE (2015) A current review of non-vascularized bone grafting in osteonecrosis of the femoral head. Curr Rev Musculoskelet Med 8(3):240–245. https://doi.org/10.1007/s12178-015-9282-y
Phemister DB (1949) Treatment of the necrotic head of the femur in adults. J Bone Joint Surg Am 31a(1):55–66
Keizer SB, Kock NB, Dijkstra PD, Taminiau AH, Nelissen RG (2006) Treatment of avascular necrosis of the hip by a non-vascularised cortical graft. J Bone Joint Surg Br 88(4):460–466. https://doi.org/10.1302/0301-620x.88b4.16950
Israelite C, Nelson CL, Ziarani CF, Abboud JA, Landa J, Steinberg ME (2005) Bilateral core decompression for osteonecrosis of the femoral head. Clin Orthop Relat Res 441:285–290
Boettcher WG, Bonfiglio M, Smith K (1970) Non-traumatic necrosis of the femoral head. II. Experiences in treatment. J Bone Joint Surg Am 52(2):322–329
Smith KR, Bonfiglio M, Montgomery WJ (1980) Non-traumatic necrosis of the femoral head treated with tibial bone-grafting. A follow-up note. J Bone Joint Surg Am 62(5):845–847
Yu PA, Peng KT, Huang TW, Hsu RW, Hsu WH, Lee MS (2015) Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: a 5-year follow-up. Biom J 38(3):257–261. https://doi.org/10.4103/2319-4170.138307
Wang CJ, Huang CC, Wang JW, Wong T, Yang YJ (2012) Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight- to nine-year follow-up. Biom J 35(6):481–485. https://doi.org/10.4103/2319-4170.104413
Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG (2003) Vascularized compared with nonvascularized fibular grafting for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Am 85-a(4):589–596
Buckley PD, Gearen PF, Petty RW (1991) Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 73(9):1357–1364
Nelson LM, Clark CR (1993) Efficacy of phemister bone grafting in nontraumatic aseptic necrosis of the femoral head. J Arthroplast 8(3):253–258
Mont MA, Hungerford DS (1995) Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 77(3):459–474
Bonfiglio M (1982) Technique of core biopsy and tibial bone grafting (Phemister procedure) for treatment of aseptic necrosis of the femoral head. Iowa Orthop J 2:57–62
Gardeniers J (1993) ARCO (Association Research Circulation Osseous) international classification of osteonecrosis. ARCO Committee on Terminology and Staging. Report on the committee meeting at Santiago de Compostela. ARCO Newsl 5:79–82
Koo KH, Kim R (1995) Quantifying the extent of osteonecrosis of the femoral head. A new method using MRI. J Bone Joint Surg Br 77(6):875–880
Kang P, Pei F, Shen B, Zhou Z, Yang J (2012) Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study. Joint Bone Spine 79(1):67–72. https://doi.org/10.1016/j.jbspin.2011.02.020
Seyler TM, Marker DR, Ulrich SD, Fatscher T, Mont MA (2008) Nonvascularized bone grafting defers joint arthroplasty in hip osteonecrosis. Clin Orthop Relat Res 466(5):1125–1132. https://doi.org/10.1007/s11999-008-0211-x
Wei BF, Ge XH (2011) Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int 21(2):206–210. https://doi.org/10.5301/hip.2011.6525
Mont MA, Etienne G, Ragland PS (2003) Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res 417:84–92. https://doi.org/10.1097/01.blo.0000096826.67494.38
Zuo W, Sun W, Zhao D, Gao F, Su Y, Li Z (2016) Investigating clinical failure of bone grafting through a window at the femoral head neck junction surgery for the treatment of osteonecrosis of the femoral head. PLoS One 11(6):e0156903. https://doi.org/10.1371/journal.pone.0156903
Lieberman JR, Engstrom SM, Meneghini RM, SooHoo NF (2012) Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res 470(2):525–534. https://doi.org/10.1007/s11999-011-2050-4
Wen PF, Guo WS, Zhang QD, Gao FQ, Yue JA, Liu ZH, Cheng LM, Li ZR (2017) Significance of lateral pillar in osteonecrosis of femoral head: a finite element analysis. Chin Med J 130(21):2569–2574. https://doi.org/10.4103/0366-6999.217077
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There is no conflict of interest throughout the whole study.
Rights and permissions
About this article
Cite this article
Wu, CT., Yen, SH., Lin, PC. et al. Long-term outcomes of Phemister bone grafting for patients with non-traumatic osteonecrosis of the femoral head. International Orthopaedics (SICOT) 43, 579–587 (2019). https://doi.org/10.1007/s00264-018-4013-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-018-4013-9