Advantages and disadvantages of common methods of hip-conserving surgery for osteonecrosis of femoral head / 中国组织工程研究

ABSTRACT

BACKGROUND: There are many methods for the treatment of non-traumatic necrosis of the femoral head. In the clinical treatment, various stages of necrosis are the decisive factors for the choice of operation. In the past, there are many studies about the effectiveness of various techniques, but few studies concern the causes of failure or risk assessment. OBJECTIVE: To explore whether other internal and external factors affect the success rate of hip preservation besides necrosis stage. METHODS: The first author retrieved PubMed, Web of Science, Medline, CNKI and Wanfang database for related studies published from 2010 to 2019. The key words were “osteonecrosis of femoral head, core decompression, non-vascularized bone grafting, vascularized free bone grafting, porous tantalum rod implantation, osteotomy, biological agents, cytotherapy” in English, and “hip-conserving surgery, hip preservation, core decompression, bone graft without blood vessel, bone graft with blood vessel, porous tantalum rod placement, osteotomy, biologics, cell therapy” in Chinese. A total of 214 articles were retrieved, and the full text was consulted. Based on the inclusion and exclusion criteria, 70 articles were finally included for analysis and summary. RESULTS AND CONCLUSION: (1) The advantages and disadvantages of each hip-conserving surgery should be evaluated. (2) Although core decompression is simple, it should not be used alone; the lateral column should be reserved properly when the non-vascularized bone transplantation is used to clean up the dead bone, so as to deal with the mechanical weakening; the blood loss and fracture risk are higher when the vascularized bone transplantation is converted to total hip replacement; the stress concentration is easily caused by tantalum rod implantation, and the clinical application is less. (3) Osteotomy, as a kind of hip-conserving surgery with great trauma, should be planned in detail for patients’ age, body mass index, and necrotic range, besides considering the necrotic stage. (4) The risk of total hip replacement should be considered in the long run no matter which operation. (5) The combination of various surgical methods and biological agents may achieve better results.