Lantern-shaped screw loaded with autologous bone for treating osteonecrosis of the femoral head

doi:10.1186/s12891-018-2243-z

. 2018 Sep 5;19(1):318.

doi: 10.1186/s12891-018-2243-z.

Lantern-shaped screw loaded with autologous bone for treating osteonecrosis of the femoral head

Dasheng Lin^{1

2}, Lei Wang³, Zhaoliang Yu⁴, Deqing Luo³, Xigui Zhang⁵, Kejian Lian³

Affiliations

¹ Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China. linds@xmu.edu.cn.
² Department of Surgery, Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-University (LMU), 80336, Munich, Germany. linds@xmu.edu.cn.
³ Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China.
⁴ Weigao Orthopaedic Device Co., Ltd, Weihai, 264200, China.
⁵ Double Engine Medical Material Co., Ltd, Xiamen, 361000, China.

PMID: 30185196
PMCID: PMC6123930
DOI: 10.1186/s12891-018-2243-z

Lantern-shaped screw loaded with autologous bone for treating osteonecrosis of the femoral head

Dasheng Lin et al. BMC Musculoskelet Disord. 2018.

. 2018 Sep 5;19(1):318.

doi: 10.1186/s12891-018-2243-z.

Authors

Dasheng Lin^{1

2}, Lei Wang³, Zhaoliang Yu⁴, Deqing Luo³, Xigui Zhang⁵, Kejian Lian³

Affiliations

¹ Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China. linds@xmu.edu.cn.
² Department of Surgery, Experimental Surgery and Regenerative Medicine, Ludwig-Maximilians-University (LMU), 80336, Munich, Germany. linds@xmu.edu.cn.
³ Orthopaedic Center of People's Liberation Army, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, 363000, China.
⁴ Weigao Orthopaedic Device Co., Ltd, Weihai, 264200, China.
⁵ Double Engine Medical Material Co., Ltd, Xiamen, 361000, China.

PMID: 30185196
PMCID: PMC6123930
DOI: 10.1186/s12891-018-2243-z

Abstract

Background: Treatment for osteonecrosis of the femoral head (ONFH) in young individuals remains controversial. We developed a lantern-shaped screw, which was designed to provide mechanical support for the femoral head to prevent its collapse, for the treatment of ONFH. The purpose of this study was to investigate the efficacy and safety of the lantern-shaped screw loaded with autologous bone for the treatment of pre-collapse stages of ONFH.

Methods: Thirty-two patients were randomly divided into two groups: the lantern-shaped screw group (core decompression and lantern-shaped screw loaded with autogenous bone) and the control group (core decompression and autogenous bone graft). During 36 months follow-up after surgery, treatment results in patients were assessed by X-ray and computed tomography (CT) scanning as well as functional recovery Harris hip score (HHS).

Results: Successful clinical results were achieved in 15 of 16 hips (94%) in the lantern-shaped screw group compared with 10 of 16 hips (63%) in the control group (p = 0.0325). Successful radiological results were achieved in 14 of 16 hips (88%) in the lantern-shaped screw group compared with 8 of 16 hips (50%) in the control group (P = 0.0221).

Conclusion: The lantern-shaped screw loaded with autologous bone for the treatment of pre-collapse stages of ONFH is effective and results in preventing progression of ONFH and reducing the risk of femoral head collapse.

Trial registration: The trial registration number: ChiCTR-TRC-13004078 (retrospectively registered at 2013-11-28).

Keywords: Autogenous bone graft; Core decompression; Lantern-shaped screw; Osteonecrosis of the femoral head.

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Conflict of interest statement

Ethics approval and consent to participate

This prospective and randomized controlled study was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-13004078). This study was carried out in accordance with the guidelines of the Declaration of Helsinki. All experimental protocols were approved by our institutional review board (Xiamen University Ethical Review Committee), and written informed consent was obtained from all study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
The lantern-shaped screw. a Photo of the folding lantern-shaped screw. b Photo of the unfolding lantern-shaped screw. c Photo of the structure and composition of the lantern-shaped screw. d Photo of the supporting equipment for the lantern-shaped screw. e Photo of the lantern-shaped screw and the angle plate with a locking tail cap (black arrow)

**Fig. 2**
Intraoperative radiography for evaluation of surgical procedure. a Insertion of the lantern-shaped screw. b The lantern-shaped screw was being unfolded. c The lantern-shaped screw was the achievement of surface at surface support for the subchondral bone of femoral head

**Fig. 3**
Representative radiographic images from both preoperative and postoperative taken at immediately after the lantern-shaped screw implantation and 36 months. **a-c** Preoperative X-ray, CT and sagittal T2-weighted magnetic resonance image showing ARCO stage III ONFH in a man aged 29 years. d and e X-ray anteroposterior view on the day of surgery. f-h X-ray and CT scans at 36 months after surgery showing union

**Fig. 4**
The figure shows survival with requirement for further hip surgery as the endpoint. The survival rate was different between the lantern-shaped screw group (94%) and the control group (69%) at 36 months (P = 0.0628)

See this image and copyright information in PMC

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References

1. Kose KC. Femoral head resurfacing for the treatment of osteonecrosis in the young patient. Clin Orthop Relat Res. 2004;425:290. doi: 10.1097/01.blo.0000136837.44993.80. - DOI - PubMed
1. Motomura G, Yamamoto T, Yamaguchi R, Ikemura S, Nakashima Y, Mawatari T, et al. Morphological analysis of collapsed regions in osteonecrosis of the femoral head. J Bone Joint Surg Br. 2011;93(2):184–187. doi: 10.1302/0301-620X.93B225476. - DOI - PubMed
1. Li W, Sakai T, Nishii T, Nakamura N, Takao M, Yoshikawa H, et al. Distribution of TRAP-positive cells and expression of HIF-1alpha, VEGF, and FGF-2 in the reparative reaction in patients with osteonecrosis of the femoral head. J Orthop Res. 2009;27(5):694–700. doi: 10.1002/jor.20802. - DOI - PubMed
1. Karasuyama K, Yamamoto T, Motomura G, Sonoda K, Kubo Y, Iwamoto Y. The role of sclerotic changes in the starting mechanisms of collapse: a histomorphometric and FEM study on the femoral head of osteonecrosis. Bone. 2015;81:644–648. doi: 10.1016/j.bone.2015.09.009. - DOI - PubMed
1. Hungerford DS. Core decompression of the femoral head for osteonecrosis. J Bone Joint Surg Am. 1988;70:474–475. doi: 10.2106/00004623-198870030-00028. - DOI - PubMed

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[1] Kose KC. Femoral head resurfacing for the treatment of osteonecrosis in the young patient. Clin Orthop Relat Res. 2004;425:290. doi: 10.1097/01.blo.0000136837.44993.80. - DOI - PubMed

[2] Kose KC. Femoral head resurfacing for the treatment of osteonecrosis in the young patient. Clin Orthop Relat Res. 2004;425:290. doi: 10.1097/01.blo.0000136837.44993.80. - DOI - PubMed

[3] Motomura G, Yamamoto T, Yamaguchi R, Ikemura S, Nakashima Y, Mawatari T, et al. Morphological analysis of collapsed regions in osteonecrosis of the femoral head. J Bone Joint Surg Br. 2011;93(2):184–187. doi: 10.1302/0301-620X.93B225476. - DOI - PubMed

[4] Motomura G, Yamamoto T, Yamaguchi R, Ikemura S, Nakashima Y, Mawatari T, et al. Morphological analysis of collapsed regions in osteonecrosis of the femoral head. J Bone Joint Surg Br. 2011;93(2):184–187. doi: 10.1302/0301-620X.93B225476. - DOI - PubMed

[5] Li W, Sakai T, Nishii T, Nakamura N, Takao M, Yoshikawa H, et al. Distribution of TRAP-positive cells and expression of HIF-1alpha, VEGF, and FGF-2 in the reparative reaction in patients with osteonecrosis of the femoral head. J Orthop Res. 2009;27(5):694–700. doi: 10.1002/jor.20802. - DOI - PubMed

[6] Li W, Sakai T, Nishii T, Nakamura N, Takao M, Yoshikawa H, et al. Distribution of TRAP-positive cells and expression of HIF-1alpha, VEGF, and FGF-2 in the reparative reaction in patients with osteonecrosis of the femoral head. J Orthop Res. 2009;27(5):694–700. doi: 10.1002/jor.20802. - DOI - PubMed

[7] Karasuyama K, Yamamoto T, Motomura G, Sonoda K, Kubo Y, Iwamoto Y. The role of sclerotic changes in the starting mechanisms of collapse: a histomorphometric and FEM study on the femoral head of osteonecrosis. Bone. 2015;81:644–648. doi: 10.1016/j.bone.2015.09.009. - DOI - PubMed

[8] Karasuyama K, Yamamoto T, Motomura G, Sonoda K, Kubo Y, Iwamoto Y. The role of sclerotic changes in the starting mechanisms of collapse: a histomorphometric and FEM study on the femoral head of osteonecrosis. Bone. 2015;81:644–648. doi: 10.1016/j.bone.2015.09.009. - DOI - PubMed

[9] Hungerford DS. Core decompression of the femoral head for osteonecrosis. J Bone Joint Surg Am. 1988;70:474–475. doi: 10.2106/00004623-198870030-00028. - DOI - PubMed

[10] Hungerford DS. Core decompression of the femoral head for osteonecrosis. J Bone Joint Surg Am. 1988;70:474–475. doi: 10.2106/00004623-198870030-00028. - DOI - PubMed

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