| ObjectiveRegarding the prognosis of hip preservation treatment for non-traumatic osteonecrosis of the femoral head(ONFH),there are many factors involved in the process.This study aimed to analyze the clinical risk factors related to the failure of hip preservation surgery,autologous concentrated bone marrow mononuclear cells grafting following core decompression(CD group)and "lightbulb" operation(LB group),based on China-Japan friendship hospital(CJFH)typing classification system in early stage ONFH.MethodsThe study was approved by the ethics committee of China-Japan friendship hospital.Patients who met both the inclusion criterias and exclusion criterias,were consecutively enrolled and received treatments as the standards of China-Japan friendship hospital orthopedic department.The reliability and reproducibility of CJFH typing classification were evaluated by randomly selected clinical data from enrolled.All patients were followed up regularly,VAS score and Harris hip score(HHS)as clinical evaluation,and radiographic evaluation with hip X-ray examination.Clinical endpoint events were marked by significant worsen pain,a poor HHS<70,progressive or collapse of the femoral head requiring further intervention.Risk factors included sex,age,etiology,time of onset,preoperative CJFH type,preoperative ARCO stage and preoperative HHS.Univariate risk analyses and COX regression multivariate risk model were performed to evaluate the risk factors,and risk assessment regression curves for each risk factors.Hazard ratio(HR)and 95%confidence interval(95%CI)were used to represent the correlation strength,and P<0.05 was considered statistically significant.ResultsA total of 312 patients(468 hips)were included in this study,and 289(433 hips)were included in the follow-up study.Radiographic data of 50 hips were randomly selected,and 2,800 reliability evaluations were performed among 8 residents,with an average Kappa value 0.711,repeatability was evaluated twice by the same resident,400 times repeatability evaluations with an average Kappa value 0.748.The important factors affecting the inconsistency of the classification were the selection of the median plane of the coronal plane image and the division of the femoral head tri-pillar.According to CJFH typing classification,67 hips as clinical failure in the CD group:type(C+M)9.1%(3/23),type L1 35.9%(24/65),type L282.4%(14/17),and type L3 66.7%(26/39).106 hips as clinical failure in LB group as follows:type(C+M)50.0%(2/4),type L1 30.8%(40/130),type L2 84.6%(22/26),and type L3 32.1%(42/131).CD group:univariate analysis showed significant differences in age and preoperative CJFH type between groups,P<0.05;COX regression multivariate risk model showed significant differences among age,preoperative CJFH type and preoperative HHS between groups,P<0.05.Age≥ 40,CJFH type L2 and L3,and preoperative HHS<80 were risk factors for clinical evaluation.LB group:univariate analysis showed significant differences in age,preoperative HHS and preoperative CJFH type between groups,P<0.05;COX regression multivariate risk model showed significant difference between preoperative CJFH type and preoperative HHS,P<0.05.CJFH type L2 and preoperative HHS<70 were risk factors for clinical evaluation.No significant difference was found between different corticosteroid induced ONFH,and no significant difference was found between different bone grafting materials.ConclusionBased on a comprehensive analysis,(1)CJFH typing classification system has a satisfying degree of inter-observer reliability consistency and intra-observer repeatability for ONFH,(2)according to CJFH typing classification,the load-bearing surface and lateral pillar structure are significant to improve the prognosis of ONFH treatment,(3)preoperative CJFH type and HHS are significant risk factors,and preoperative ARCO stage and age are also related risk factors for the treatment and prognosis evaluation in early stage of ONFH.ObjectiveThis study aimed to analyze the clinical factors related to the failure of autologous bone marrow mononuclear cells grafting(BMMCG)following core decompression(CD)in early stage non-traumatic osteonecrosis of the femoral head(ONFH).MethodsIn total,148 patients(192 hips)underwent CD with autologous BMMCG for treatment of non-traumatic ONFH.The patients were classified by their ARCO staging and China-Japan Friendship Hospital typing system.All patients were clinically and radiographically followed up every 3 months during the first year and every 6 months in the following years.The clinical evaluation was conducted by pre-and postoperative Harris hip scores,while serial anteroposterior and frog lateral radiographs were used for postoperative radiographic evaluation.Univariate and multivariate risk analyses were performed.ResultsThere were 56 hips as clinical failure cases,and 50 hips(89.29%)of failure cases developed between 3 to 10 months after operation.Based on CJFH classification system,type L2 showed more failure rate with 60.0%(9 of15).Univariate and multivariate risk analyses all showed that disease type was an independent risk factors for postoperative clinical failure.Multivariate analysis of the Cox proportional-hazards model showed that type L1 had a hazard ratio(HR)of 0.286(95%Cl 0.100-0.816),type L3 with HR of 0.245(95%CI 0.079-0.759),respectively.ConclusionDisease type is an important risk factor for autologous BMMCG combined with CD,and the degree of bearing surface and lateral pillar necrosis is a significant reference index for prognosis evaluation in early stage of ONFH. |
