Long-term outcomes of Phemister bone grafting for patients with non-traumatic osteonecrosis of the femoral head.

Autor: Wu CT; Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Da Pi Rd., Niao Sung Dist, Kaohsiung City, Taiwan, Republic of China., Yen SH; Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Da Pi Rd., Niao Sung Dist, Kaohsiung City, Taiwan, Republic of China., Lin PC; Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Da Pi Rd., Niao Sung Dist, Kaohsiung City, Taiwan, Republic of China., Wang JW; Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No. 123, Da Pi Rd., Niao Sung Dist, Kaohsiung City, Taiwan, Republic of China. wangjw@cgmh.org.tw.; College of Medicine, Chang Gung University, Kaohsiung, Taiwan. wangjw@cgmh.org.tw.
Jazyk: angličtina
Zdroj: International orthopaedics [Int Orthop] 2019 Mar; Vol. 43 (3), pp. 579-587. Date of Electronic Publication: 2018 Jun 18.
DOI: 10.1007/s00264-018-4013-9
Abstrakt: Background: Phemister procedure is an effective treatment for early stage osteonecrosis of femoral head (ONFH). Since the long-term results of the Phemister procedure are less reported in the literature, the purpose of this study was to investigate the long-term outcomes of this bone grafting technique in patients with earlier stages of ONFH.
Methods: From 1994 to 2010, 29 hips with pre-collapsed or early collapsed (< 2 mm) ONFH treated by Phemister procedure were evaluated. Among them, nine hips were Association Research Circulation Osseous (ARCO) stage IIA, 13 stage IIB, 4 stage IIC, and 3 stage IIIA. The mean age was 38.9 years. The mean follow-up was 14 years (1-21 years). Survivorship was analyzed with conversion to total hip arthroplasty (THA) as the endpoint.
Results: At the final follow-up, 10 hips underwent THA at a mean of ten years (1-18 years). The overall clinical success rate for hip preserving was 65.5%, and radiological success rate was 31%. The mean Harris Hip Score improved from 50.3 to 76.1. The survival of hips was significantly inferior in female patients (P < 0.01), ARCO stage III disease (P = 0.03), lateral type lesion (P < 0.01), and necrotic index ≥ 0.67 (P < 0.01). The Cox proportional hazards model showed that gender, ARCO stage, and necrotic index were independent risk factors for conversion to THA.
Conclusion: The study showed acceptable results without complication in patients receiving Phemister procedure for early stage ONFH at a mean follow-up of 14 years. As a head-preserving procedure, Phemister technique is worthwhile for young patients to postpone the need for THA.
Databáze: MEDLINE
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