Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis

医学 外科 股骨头 骨关节炎 缺血性坏死 截骨术 骨移植 病理 替代医学
作者
Simon D. Steppacher,Raphael Sedlmayer,Moritz Tannast,Florian Schmaranzer,Klaus A. Siebenrock
出处
期刊:Hip International [SAGE Publishing]
卷期号:30 (4): 398-406 被引量:11
标识
DOI:10.1177/1120700019856010
摘要

Does surgical hip dislocation with drilling or bone grafting, cartilage treatment and femoral osteotomy in avascular necrosis of the femoral head (AVN) result in: (1) progression of osteonecrosis or osteoarthritis; (2) pain relief and improved function; and (3) subsequent surgery and complications?We retrospectively reviewed 12 patients (13 hips, mean age 29 ± 9 years) undergoing surgical hip dislocation for AVN. Preoperative ARCO stages were: 1 hip ARCO II, 8 hips ARCO III early, 4 hips ARCO III late. Drilling was performed in 4 hips, 9 hips underwent curettage, drilling and autologous bone grafting. Cartilage was sutured in 5 hips, autologous matrix-induced chondrogenesis was performed in 3 hips, an osteochondral autograft was used in 1 hip. Femoral osteotomy was performed in 10 hips. Mean follow-up was 3 ± 2 years. Progression of AVN and osteoarthritis was assessed preoperatively and at latest follow-up using Tönnis and ARCO staging. Pain and function were assessed with the Merle d'Aubigné-Postel score. Complications were graded according to Sink et al.1 hip had AVN progression and converted to THA. 9 hips showed no AVN- or advanced osteoarthritis progression and 3 hips improved at least 1 ARCO stage. The Merle d'Aubigné-Postel score increased from preoperatively 14.1 ± 3.2 to 16.6 ± 1.2 (p = 0.012). Subsequent surgery were performed in 3 hips, complications occurred in 3 hips.Although the first results are promising a longer follow-up with more patients is needed to draw a definite conclusion regarding the joint preserving potential in AVN.

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