The Medium-term Follow-up Of The Early-middle Stage Avascular Necrosis Of The Femoral Head With Core Decompression And Bone Graft

OBJECTIVE:To evaluate the medium-term clinical effect of treatment of the early-middle stage avascular necrosis of the femoral head (ANFH) with Core Decompression and Bone Graft, Clinical use of Core Decompression and Bone Grafting for the treatment of the early-middle stage avascular necrosis of the femoral head to provide a basis.METHODS:A total of87patients (114hips) of avascular necrosis of the femoral head treated with core decompression and bone graft in the department of spinal bone diseases of the first affiliated hospital of Guangxi Medical University between January2000and December2006were reviewed retrospectively. The study included74males (97hips) and13females (17hips); the average age of38years, range from20～56years; left-unilateral ANFH20patients, right-unilateral ANFH40patients, and bilateral ANFH27patients; the pathological causes were:alcohol54cases(62.1%), hormones26cases (29.9%), and idiopathic7cases (8.0%);16hips were at Stage Ⅰ,68hips were at Stage Ⅱ, and30hips were at Stage Ⅲ. According to the classification system of the Ficat. The outcomes were assessed clinically and radiologically according to changes in the Harris hip score and progression in radiographic stages. The hip survival analysis were analyzed by the Kaplan-Meier method with replacement for any reason as the end-point.RESULTS:A total of87cases (114hips) were followed up. The mean duration of follow-up was105months with a range from60to142months. The Harris hip scores improved from73.13±7.17points Preoperatively to81.59±13.23points postoperatively. There were significant difference among the two results (p＜0.01). There were significant difference among three stages (p＜0.01). Clinical excellent and good results were abtained in93.8%of stage I,73.5%in stage Ⅱ、and46.7%in stage Ⅲ. Clinical excellent and good results for stage Ⅰ-Ⅱ is better than stage III (p＜0.01). A total of69.3%of overall clinical results were rated as good or excellent. Radiological success rate were abtained in87.5%of stage I,60.3%in stage Ⅱ and23.3%in stage Ⅲ. Radiological success rate for stage Ⅰ-Ⅱ is better than stage Ⅲ (p＜0.01). A total of54.4%of overall Radiological results were rated as successful.18hips (18 /114,15.8%) underwent total hip replacement at the end of the postoperative follow-up time, Kaplan-Meier survivorship curves showed the survival probability for stage Ⅰ was100%, for stage Ⅱ was91.2%, and for stage Ⅲ was60%. The medium and long-term survival probability for stage Ⅰ-Ⅱ is better than stage Ⅲ (p＜0.01)CONCLUSION:Core decompression with bone graft is a safe and effective procedure for the treatment of Ficat Ⅰ-Ⅱ stages (pre-collapse stage) avascular necrosis of the femoral head to relieve the hip pain, improve the function of hips joint activities, delay and even reversion the progress of course of the disease. The medium-term efficacy postoperatively is satisfactory to be confirmed. We also advise its use after collapse in patients who were in Stage Ⅲ is unsatisfactory. Although it can relieve the clinical symptoms. But It can’t effectively change joint deformities and mobility, Also it can’t absolutely prevent the progression of the collapse of the femoral head. There was a lower medium-term survival probability on stage Ⅲ. But for the patients who were reluctant to receive THR, especially in this group of young patients who fully understand the importance of delaying THR and who can be relied on to modify their activity level. Core decompression with bone graft also can delay the need for total hip replacement (THR). So it is the effective treatment of choice for them. Moreover this is a relatively simple and easy procedure, even if the long-term failure will not affect the total hip replacement.