Five-year-follow up comparative study of bone grafting pedicled with the femoral quadratus augmented with a titanium mesh for alcohol-induced osteonecrosis of the femoral head / 中华骨科杂志

ABSTRACT

Objective To investigate the mid?term follow?up results of bone grafting pedicled with the femoral quadra?tus augmented with a titanium mesh for alcohol?induced osteonecrosis of the femoral head and to analyze the technical factors affecting the surgical outcome. Methods Twenty cases (24 hips) treated with bone grafting pedicled with the femoral quadratus augmented with a titanium mesh between January 2008 and September 2009 were retrospectively reviewed. Control group includ?ed 18 cases (20 hips) treated with bone grafting pedicled with the femoral quadratus alone in the same period. All the hips were al?cohol?induced femoral head necrosis and were classified as ARCOⅡC or ARCOⅢA stage. The one hundred points method was used for outcome evaluation. Statistical analysis was performed using SPSS statistical package 13.0(SPSS Inc., USA). Results The titanium group has a longer operative time and more estimated blood loss than the bone?grafting group with statistical signifi?cance. For the twenty cases in the titanium group, two cases were lost to follow?up with another one case receiving total hip arthro?plasty due to severe collapse, and the rest were followed for an average of 62.7 (58 to 66) months. For the eighteen cases in bone-grafting group, one case was lost to follow?up with another one case receiving total hip arthroplasty due to severe collapse, and the rest were followed for an average of 61.3 (57 to 64) months. At the last follow?up, the titanium group had a successful rate of 85.7%(excellent in 13, good in 5 and fair in 2) with a five?year survival rate of 95.2%(20 out of 21 hips) and the bone?grafting group had a successful rate of 84.2%(excellent in 13, good in 3 and fair in 2) with a five?year survival rate of 94.7%(18 out of 19 hips). Clini?cal and radiographic outcomes were not statistically significant different between the two groups. Mild collapses were noted radio?graphically in both groups, with 7 out of 20 in titanium group and 5 out of 18 in the bone?grafting group. Among these mildly col?lapsed cases, the cases in titanium group had a relatively better clinical outcome than those in the control group and the cases with a larger mesh supporting area had an even better clinical outcome. Conclusion The mid?term follow?up results of bone grafting pedicled with the femoral quadratus augmented with a titanium mesh for alcohol?induced osteonecrosis of the femoral head were satisfactory. Factors affecting surgical outcomes included the placement of the titanium mesh, and the bone?grafting technique.