Published online Jul 6, 2020. doi: 10.12998/wjcc.v8.i13.2749
Peer-review started: March 2, 2020
First decision: April 22, 2020
Revised: May 14, 2020
Accepted: May 30, 2020
Article in press: May 30, 2020
Published online: July 6, 2020
Processing time: 126 Days and 5.1 Hours
Osteonecrosis of the femoral head (ONFH) is a terrible disease that usually affects young and middle-aged patients. The treatment of ONFH has been studied extensively. There are many options available for ONFH, including both nonsurgical treatment and surgical treatment. However, there is little supporting data on nonsurgical treatment when the condition is identified in the early stages. Most of the patients need a total hip arthroplasty after 2 years due to articular collapse. So effective joint-preserving surgical treatments are urgently needed for patients with early stage ONFH when outcomes of treatment are in general better than the advanced stage disease.
We would like to introduce a new technology that is safe, reliable, and effective in order for other doctors to adopt this new method for the joint-preserving treatment of ONFH.
Our study confirmed that percutaneous expanded core decompression and mixed bone graft technique is an effective joint-preserving surgical treatment for patients with early stage ONFH. It is easy to master and costs less than other methods. We want colleagues in other institutions to use it and also demonstrate its effectiveness.
From 2013 to 2019, we used percutaneous expanded core decompression and mixed bone graft technique to operate on a group of patients with ONFH. After the operation, the patients were routinely given infection prevention and venous thromboembolism prevention and asked to come to hospital for reexamination regularly while restricting weight-bearing movement for 4 wk. Through the application of a single blade expandable reamer, the core decompression can be precise and thorough. Following the decompression, the mixed bone graft is added. It consists of autologous bone, allogeneic bone, and bone marrow aspirate for a combination of biological activity and structural supporting. An excellent result was obtained by comparing Harris hip score, visual analogue scale, and imaging examination before and after operation.
All of the patients have achieved satisfactory results in our study from 2013 to 2019. After surgery their Harris hip score and visual analogue scale were improved. Radiography and computed tomography showed that the implanted bone was healed. Clinical symptoms were also significantly relieved. None of the patients needed to accept the total hip arthroplasty in 5 years after surgery. No serious perioperative complications were observed in our cases.
Percutaneous expanded core decompression and mixed bone graft technique is simple, safe, and reliable. Advantages of the single blade expandable reamer are obvious. The material of adjuvant substance is inexpensive and easy to obtain. Thus, this technique is an effective joint-preserving surgical treatment for patients with early stage ONFH. This new technique is easy to master as well as costs less than other methods. It is worth popularizing and verifying.
For future research, the effect of age, Kerboul angle, and the size and location of lesions on outcomes should be demonstrated.