Type L1 steroid-induced osteonecrosis of the femoral head through femoral head and neck junction decompression by fenestration: A single-center prospective clinical study / 中国组织工程研究

ABSTRACT

BACKGROUND: Osteonecrosis of the femoral head is a refractory disease in department of orthopedics. Especially with steroid-induced osteonecrosis, incidence rate is high, and it is easy to collapse. Increasing knowledge of hormone necrosis will help early identification and intervention, and choose reasonable treatment measures to improve prognosis. OBJECTIVE: To investigate the clinical effects and influencing factors in the treatment of different kinds of steroid-induced osteonecrosis of the femoral head of CJFH type L1 patients through femoral head and neck junction decompression by fenestration and bone grafting. METHODS: Clinical data of 82 patients (106 hips) with CJFH type L1 steroid-induced osteonecrosis of the femoral head, who underwent femoral head and neck junction decompression by fenestration in China-Japan Friendship Hospital, were analyzed. The clinical effect evaluation consisted of two parts Harris hip score system, the observation of bilateral hip joint and frog position film. Clinical endpoint events were marked by poor Harris hip score < 70, progressive collapse of the femoral head with/without obvious clinical manifestation. Univariate and multivariate analyses were used to analyze the influence of gender, age, etiology, preoperative ARCO stage, onset time and preoperative Harris score on prognosis. RESULTS AND CONCLUSION: (1) All patients were followed up, and the mean duration was 3-51 months. (2) Based on Harris hip score of the last follow-up, the results were excellent in 4 hips, good in 33 hips, fair in 50 hips, and poor in 19 hips. The excellent and good rate was 34.9% (37/106). Harris hip score was higher in the final follow-up (83.1±14.3) than that before surgery (64.4±9.8) (P < 0.05). (3) Imaging results demonstrated that there were 15 hips with progressive collapse of the femoral head, and 6 hips without obvious clinical symptoms. (4) The 26 hips were classified as clinical failed. Univariate and multivariate analyses showed that preoperative Harris hip score < 70 was the independent risk factor for prognosis of osteonecrosis of the femoral head (P < 0.05). There was no significant difference among different types of steroid-induced osteonecrosis of the femoral head. (5) The method through femoral head and neck junction decompression by fenestration and bone grafting has a good effectiveness in patients with type L1 steroid-induced osteonecrosis of the femoral head in short and medium terms, but preoperative Harris hip score < 70 is a risk factor affecting the prognosis of hip preservation.