Nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft for the treatment of ARCO stage III osteonecrosis of the femoral head / 中国组织工程研究

ABSTRACT

BACKGROUND: It remains controversial whether patients with ARCO stage III osteonecrosis of the femoral head should be treated with femoreal head preserving surgery, and what the clinical efficacy of femoreal head preserving surgery is. OBJECTIVE: To investigate the clinical efficacy of nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft in the treatment of ARCO stage III osteonecrosis of the femoral head METHODS: From March 2017 to September 2018, 36 patients (32 male and 4 female, 16-58 years old) with ARCO state III osteonecrosis of the femoral head who received treatment in Aviation General Hospital were included in this study. Among these patients, three had bilateral osteonecrosis of the femoral head and 33 had unilateral osteonecrosis of the femoral head. According to ARCO classification, 35 hips fell into stage IIIA, 3 hips in stage IIIB, and 1 hip in stage IIIC. All included paitents underwent nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft. Postoperative follow up was performed. Hip joint function was evaluated using Harris hip score. The degree of collapse of the femoral head was evaluated using X-ray imaging. The osteogenesis in the necrotic area was determined by CT scans. This study was approved by Aviation General Hospital Ethics Committee (Ethics code HK2019-01-04). RESULTS AND CONCLUSION: (1) Thirty-six patients were followed up for (19.28±6.51) months. At the last follow-up, 4 hips ultimately underwent total hip arthroplasty with the success rate of 89.7%(35/39). (2) Harris hip score revealed that at the last follow-up, the excellent and good rate of hip function was significantly higher than that before surgery (71.8%,17.5%, P=0.000). (3) Last follow-up CT scans revealed obvious osteogenesis was observed in 26 of 35 hips at ARCO stage IIIA and it was observed in neither 3 hips at ARCO stage IIIB nor in 1 hip at ARCO stage IIIC. (4) At the last follow-up, X-ray showed that there was progress in 5 of the 35 hips (IIIA), 3 of which progressed to ARCO stage IIIB, 2 to ARCO stage IV, and the remaining 30 hips were stable without progression; three hips in ARCO stage IIIB progressed, including 2 progressed to ARCO stage IIIC and 1 to ARCO stage IV; 1 hip in ARCOIIIC stage progressed to ARCO stage IV. The results suggest that nano-hydroxyapatite/polyamide 66 support rod combined with bone allograft has a good effect on the treatment of ARCO stage III osteonecrosis of the femoral head.