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. 2009 Feb;33(1):41-7.
doi: 10.1007/s00264-007-0455-1. Epub 2007 Nov 9.

Long-term results of decompression and muscle-pedicle bone grafting for osteonecrosis of the femoral head

Durgapada P Baksi  1 , Ananda Kisor Pal, Debadyuti D Baksi
Affiliations

Long-term results of decompression and muscle-pedicle bone grafting for osteonecrosis of the femoral head

Durgapada P Baksi et al. Int Orthop. 2009 Feb.

Abstract
in English, French

In this paper, 152 patients with 187 osteonecrotic femoral heads (83 idiopathic, 56 corticosteroid induced, 40 post-traumatic, seven alcohol abuse and one associated with gout) were classified according to the staging by Ficat and Arlet (Ischemia and necroses of bone, Williams and Wilkins, Baltimore, Maryland, pp 171-182, 1980); four were in Stage I, 82 in Stage II and 101 in Stage III. The majority of the patients were young (average age 35.5 years). Multiple drilling, curettage of the necrotic bone and muscle-pedicle bone grafting using tensor fascia lata was carried out in all patients except in six adolescents, where sartorius grafting was performed. Cheilectomy of the femoral head and subcutaneous adductor tenotomy were also performed in the advanced stages. During the follow up of 10 to 21.5 years (average 16.5 years), radiological improvement was noted in 81.3% of patients in Stage II and 70.1% of patients in Stage III cases. Excellent and good results according to the Hospital for Special Surgery (HSS) score were obtained in 100% of cases in Stage I, 92% in Stage II and 80.4% in stage III, with a survivorship of 91% in Stage II and 82% in Stage III cases. The patients having an HSS score below 20 (non-survival) were recommended for total hip replacement (THR) therapy.

152 patients présentant 187 nécroses de la tête fémorale (83 idopathiques, 56 après corticoïdes, 40 post-traumatiques, 7 d’origine éthyliques et une associée à une goutte) ont été traités. Selon les classifications de Ficat et Arlet, 4 étaient au stade I, 82 au stade II et 101 au stade III. La majorité des patients étaient jeunes (35,5 ans). Forage et curetage de la nécrose et greffe pédiculaire ont été réalisés chez 6 adolescents. Cheilectomie et ténotomie percutanées des adducteurs ont été également réalisées. Le suivi moyen a été de 16.5 ans (10 à 21.5 ans). Il n’y a pas d’altération radiographique chez les patients de stade I. Une amélioration a été notée dans 81.3% des patients de stade II et 70.1% des patients de stade III. De bons résultats cliniques ont été mis en évidence (score de Salvati et Wilson) dans 100% des patients de stade I, 92% au stade II et 80.4% au stade III avec un taux de survie de 91% au stade II, et 82% de stade III. Les patients présentant une aggravation de la nécrose avec un score en dessous de 20 ont été considérés comme devant bénéficier d’une prothèse totale.

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Figures

Fig. 1
Fig. 1
Tensor fascia lata (TFL) muscle-pedicle bone graft (MPBG) is prepared with the passage of a Vicryl thread through the bone. A slot with multiple drill holes at its depth is shown over the antero-superior aspect of the femoral head for grafting. The line of cheilectomy is shown by dotted lines over the deformed femoral head. Two drill holes are shown on either side of the slot for the passage of the Vicryl thread for anchoring the graft through its fascial sleeve after impaction inside the slot (inset)
Fig. 2
Fig. 2
a Preoperative antero-posterior (AP) radiograph of a 35-year-old lady with bilateral idiopathic osteonecrosis (Stage III) with 2-mm collapse. b Seventeen-year follow up AP radiograph of the same patient showing satisfactory healing of the necrotic area, with further improvement of the shape of the femoral head. The clinical result was excellent (hip score=34)
Fig. 3
Fig. 3
Kaplan-Meier survival probabilities for Stage II (at 10 years and 15 years after operation) with 95% confidence intervals (shown by the dotted lines)
Fig. 4
Fig. 4
Kaplan-Meier survival probabilities for Stage III (at 10 and 15 years after operation) with 95% confidence intervals (shown by the dotted lines)
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