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Jiang W, Sanchez J, Dhodapkar MM, Li M, Wiznia D, Grauer JN. Femoral Head Core Decompressions: Characterization of Subsequent Conversion to Total Hip Arthroplasty and Related Complications. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00005. [PMID: 38437034 PMCID: PMC10906578 DOI: 10.5435/jaaosglobal-d-24-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Core decompression is a minimally invasive joint-preserving approach for early-stage osteonecrosis. The rate at which core decompression patients require total hip arthroplasty (THA) and rates of perioperative adverse outcomes have not been well-characterized. METHODS Adult patients undergoing core decompression and/or THA with osteonecrosis of the femoral head were identified from the 2015 to 2021 Q3 PearlDiver M157 database. Those undergoing THA without or with antecedent core decompression were identified and matched 4:1 on age, sex, and Elixhauser Comorbidity Index. Postoperative 90-day adverse events were compared with multivariable analysis. Five-year rates of revision, dislocation, and periprosthetic fracture were compared by the Kaplan-Meier curve and log-rank tests. RESULTS Core decompressions were identified for 3,025 patients of whom 387 (12.8%) went on to THA within 5 years (64% within the first year). The median time from initial core decompression to THA was 252 days. For THA, 26,209 adults were identified and 387 had prior core decompression. After matching, there were 1,320 without core decompression and 339 with core decompression. No statistically significant differences were observed in 90-day postoperative adverse events or 5-year rates of revision, dislocation, or periprosthetic fracture. CONCLUSION Core decompression may be an option for patients with osteonecrosis and does not seem to affect THA outcomes if required later.
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Affiliation(s)
- Will Jiang
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
| | - Joshua Sanchez
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
| | - Meera M. Dhodapkar
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
| | - Mengnai Li
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
| | - Daniel Wiznia
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
| | - Jonathan N. Grauer
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
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Mo L, Li J, Wang Z, Huang F, Xin P, Zhou C, He W, Liu Y. Influence of less invasive hip preservation surgery on subsequent hip arthroplasty for osteonecrosis of the femoral head. J Hip Preserv Surg 2022; 9:197-205. [PMID: 35992024 PMCID: PMC9389913 DOI: 10.1093/jhps/hnac035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/19/2022] [Accepted: 07/27/2022] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) following less invasive hip-preserving procedures (LIHPs) and present a critical overview of the literature to aid in better result interpretation. The search time was from the establishment of the database to September 2021, and the outcome indicators were extracted and analyzed by Cochrane Collaboration Review Manager software (RevMan version 5.4). Finally, 10 articles were included in this meta-analysis by searching Chinese databases and English databases. Three of them were published in Chinese, and the remaining studies were published in English. LIHP was further divided into the tantalum rod implantation group and the non-tantalum rod implantation group. The results showed that prior tantalum rod implantation increased the difficulty of conversion to THA, which was reflected mainly in the longer operative time [weighted mean difference (WMD) = 24.50, 95% confidence interval (CI) = 14.09–34.91, P < 0.00001] and greater intraoperative blood loss (WMD = 114.74, 95% CI = 33.52–195.96, P = 0.006), while no significant difference was found between the non-tantalum rod implantation group and the control group. Simultaneously, easier intraoperative fracture [odds ratio (OR) = 5.88, 95% CI = 0.93–37.05, P = 0.06] and stem malalignment (OR = 4.17, 95% CI = 1.18–14.71, P = 0.03) in the LIHP group tended to be observed than in the control THA group. However, there was no significant difference in cup anteversion and inclination angle, ectopic ossification, postoperative Harris Hip Score and survivorship between the LIHP group and the control group. Although LIHP increased the difficulty of the conversion to THA, it does not detrimentally affect the clinical results of subsequent THA in the mid-term follow-up.
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Affiliation(s)
- Liang Mo
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Jianxiong Li
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Zhangzheng Wang
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Fayi Huang
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Pengfei Xin
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Chi Zhou
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
| | - Wei He
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
- Guangdong Research Institute for Traumatology & Orthopedics , Guangzhou, Guangdong Province 510378, China
| | - Yuhao Liu
- The First Clinical School of Guangzhou University of Chinese Medicine , Guangzhou, Guangdong Province 510405, China
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Zhang Z, Lin T, Zhong Y, Song W, Yang P, Wang D, Yang F, Zhang Q, Wei Q, He W. Effect of femoral head necrosis cystic area on femoral head collapse and stress distribution in femoral head: A clinical and finite element study. Open Med (Wars) 2022; 17:1282-1291. [PMID: 35892078 PMCID: PMC9281584 DOI: 10.1515/med-2022-0506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to investigate the effect of cystic areas of osteonecrosis of the femoral head (ONFH) on stress distribution and disease progression in the femoral head. A total of 85 patients (106 hips) diagnosed with Association Research Circulation Osseous stage II non-traumatic and non-surgical treatment were retrospectively analyzed. The presence of cystic areas and diameter of cystic areas were compared between the two groups. In addition, five spherical cystic areas of different diameters were constructed and the maximum stress was observed. There was a difference between the two groups in whether cystic areas appeared in the femoral head, with 49.1% in the collapse group showing cystic areas, which was significantly higher than that in the non-collapse group (18.4%) (P < 0.05). In addition, the diameter of the cystic areas was significantly larger in the collapsed group than in the non-collapsed group (P < 0.05). The maximum and mean von Mises stress value around the necrotic area and around the cystic area of the femoral head increased with the increase of the cystic diameter. Stress concentration areas can be generated around the cystic areas. The presence and increased diameter of the cystic areas accelerates the collapse of the ONFH femoral head.
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Affiliation(s)
- Zhaoming Zhang
- Department of Orthopedics, The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China.,Department of Orthopedics, Affiliated Foshan Hospital, Guangzhou University of Traditional Chinese Medicine, Foshan 528000, China
| | - Tianye Lin
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China
| | - Yuan Zhong
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China.,Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510240, China
| | - Wenting Song
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China.,Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510240, China
| | - Peng Yang
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China.,Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510240, China
| | - Ding Wang
- Department of Orthopedics, Affiliated Foshan Hospital, Guangzhou University of Traditional Chinese Medicine, Foshan 528000, China
| | - Fan Yang
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China.,Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510240, China
| | - Qingwen Zhang
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China.,Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510240, China
| | - Qiushi Wei
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China.,Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510240, China
| | - Wei He
- Department of Orthopedics, Guangdong Research Institute for Orthopedic & Traumatology of Chinese Medicine, Guangzhou, Guangdong 510240, China.,Department of Joint Orthopaedic, The Third Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510240, China
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Yoshizawa T, Yoshioka T, Sugaya H, Nishino T, Tomaru Y, Wada H, Akaogi H, Yamazaki M, Mishima H. Total Hip Arthroplasty After Failed Hip-Preserving Surgery with Concentrated Autologous Bone Marrow Aspirate Transplantation for Osteonecrosis of the Femoral Head: A Retrospective Study. Indian J Orthop 2022; 56:1251-1258. [PMID: 35813540 PMCID: PMC9232665 DOI: 10.1007/s43465-022-00603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Since 2003, a hip-preserving technique-concentrated autologous bone marrow aspirate transplantation (CABMAT)-has been applied to treat osteonecrosis of the femoral head (ONFH). We investigated intraoperative and postoperative outcomes of total hip arthroplasty (THA) in patients who underwent CABMAT as hip-preserving surgery for ONFH but developed secondary hip osteoarthritis after progressive femoral head collapse. METHODS A total of 456 hips in 282 patients underwent CABMAT in our hospital between April 2003 and December 2018; 108 hips required THA (THA conversion rate, 23.7%). We enrolled 60 hips (26 hips in 20 men and 34 in 26 women) with a follow-up of over 2 years. We retrospectively analyzed patient background data, time to THA, surgical procedure, postoperative complications, and clinical outcomes from medical records. RESULTS The disease was steroid-related, alcohol-related, and idiopathic in 48, seven, and five hips, respectively. The mean age at THA was 45.7 years, and mean conversion time was 2.7 years. Cementless THA was performed in all cases; the mean operating time and blood loss were 82.7 min and 210 g, respectively. Postoperative complications were observed in four cases; intraoperative fracture, two cases; superficial infection, one case; and dislocation, one case. The mean follow-up period was 5.7 years; no loosening or deep infections occurred. No patients required revision arthroplasty. CONCLUSION We noted no complications related to CABMAT. After a minimum 2-year follow-up, the clinical outcomes were good. CABMAT was found to be an useful hip-preserving surgery, with little effect on conversion to THA, and THA outcomes were good.
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Affiliation(s)
- Tomohiro Yoshizawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Tomokazu Yoshioka
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 Japan
| | - Hisashi Sugaya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Tomofumi Nishino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Yohei Tomaru
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Hiroshi Wada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Hiroshi Akaogi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Japan
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