Robot-assisted core decompression combined with bone grafting in the treatment of early osteonecrosis of femoral head / 中华骨科杂志

ABSTRACT

Objective:To explore the clinical effect of robot-assisted core decompression combined with bone grafting in the treatment of early-stage osteonecrosis of femoral head.Methods:The data of 49 patients (84 hips) who attended the Department of Orthopedics and Joint Surgery of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2019 to February 2021 were retrospectively analyzed. All the patients suffering Association Research Circulation Osseous (ARCO) II stage of osteonecrosis of femoral head underwent core decompression and bone grafting. Among the patients undergoing surgery, 30 patients (54 hips), including 19 males and 11 females, aged 44.3±5.4 years (range, 21 to 59 years) were treated with conventional surgical methods, and 19 patients (30 hips), including 12 males and 7 females, aged 41.4±7.2 years (range, 20 to 58 years), were assisted by the orthopedic robot navigation system. All operations were performed by the same operator. All patients were informed of the conventional and robotic surgical options by the surgeon at admission, and the patients made the decision. The baseline data of the two groups of patients, the time of unilateral operation, the number of unilateral X-ray fluoroscopy, the Harris hip score at the last follow-up after surgery, the visual analog score (VAS), and the collapse rate at the last follow-up were collected and compared.Results:A total of 41 patients (70 hips) were followed up, including 24 cases (42 hips) in the conventional surgery group and 17 cases in the robot-assisted group (28 hips). The average follow-up time of all cases was 14.6±4.8 months (range, 3 to 21 months). At the last follow-up, a total of 13 patients (13 hips) suffered femoral head surface collapse, including 11 patients in the conventional surgery group (11 hips) and 2 patients in the robot-assisted group (2 hips). The rate of femoral head collapse between the two groups had statistical difference ( P=0.045). The average operation time of unilateral hip in the conventional operation group was 21.3±5.4 min, and 16.8±3.3 min in the robot-assisted group, with significant difference ( t=3.94, P<0.001). The number of X-ray fluoroscopy of unilateral hip in the conventional operation group was 14.4±3.8 times, and 9.6±2.1 times in the robot-assisted group, with significant difference ( t=6.08, P<0.001). The Harris hip score before surgery in the conventional surgery group was 68.4±4.5 points, and 85.1±3.8 points at the last follow-up, while the preoperative Harris hip score of the robot-assisted surgery group was 67.2±3.9 points, and 86.5±4.4 points at the last follow-up. The Harris hip scores at the last follow-up of the two groups were significantly different from those before the operation, but there was no difference between the two groups after surgery ( t=1.09, P=0.283). The preoperative VAS of the conventional surgery group was 4.8±1.7 points, and 1.7±0.8 points at the last follow-up. The preoperative VAS of the robot-assisted surgery group was 5.1±1.5 points, and 0.9±0.3 points at the last follow-up. Τhere were significant differences between the two groups regarding the VAS in the last follow-up ( t=3.92, P<0.001). Conclusion:Core decompression combined with bone grafting have a definite effect in the treatment of osteonecrosis of ARCO II stage of osteonecrosis of femoral head. Compared with conventional surgery, robot-assisted surgery can achieve better short-term results and head preservation rate.