[Treatment of avascular necrosis of the femoral head by lesions clearance, compact bone grafting, and porous tantalum rod implantation]

Abstract

Objective: To study the effectiveness of avascular necrosis of the femoral head treated by lesions clearance,

Methods: Between March 2008 and May 2010, 14 patients (16 compact bone grafting, and porous tantalum rod implantation. hips) with avascular necrosis of the femoral head were treated by lesions clearance, compact bone grafting, and implantation of porous tantalum rod. Of 15 cases, 13 were male (15 hips) and 1 was female (1 hip) with a median age of 42.2 years (range, 18-73 years), including traumatic in 1 case (1 hip), alcoholic in 4 cases (4 hips), and steroid-induced in 9 cases (11 hips); 3 hips were at Association Research Circulation Osseous (ARCO) stage I and 13 hips were at ARCO stage II. The Harris score was 51.89 +/- 12.42, and the X-ray score was 31.88 +/- 4.03. All the cases were diagnosed by X-ray films and MRI. The median disease duration was 2.5 years (range, 6 months to 7 years). All the patients accepted the operation of lesions clearance by slotting at the neck of femur, then, compact bone grafting, and implantation of porous tantalum rod were performed. The affected limb could not bear weight loading at 1-3 months after operation and partly bear weight loading after 3 months of operation.

Results: Primary healing of incision was achieved in all patients and no complication occurred. The patients were followed up 24 months on average (range, 13-36 months). Two patients underwent total hip arthroplasty at 4 months and 2 years respectively because of even worsened pain and collapsed femoral heads; 12 patients achieved obvious pain relief with a survival rate 87.5% (14/16). The postoperative Harris score was 84.89 +/- 17.96, showing significant difference when compared with preoperative score (t = -8.038, P = 0.001). The X-ray examination showed definite ossification, increased density, regular arrangement of the trabeculae and no collapsed femoral head. The X-ray score was 32.19 +/- 6.57, showing no significant difference when compared with preoperative score (t = -2.237, P = 0.819).

Conclusion: Lesions clearance, compact bone grafting, and implantation of porous tantalum rod for avascular necrosis of the femoral head have a good short-term clinical result.