• Bone graft
• Core decompression
• Hip-joint preservation
• Osteonecrosis of the femoral head
• Tissue engineering
• Treatment

• ARCO III
• Jack surgery
• collapse
• hip preservation
• osteochondral lifting surgery
• osteonecrosis of femoral head

• Humans
• Femur Head Necrosis/surgery
• Femur Head Necrosis/diagnostic imaging
• Male
• Female
• Retrospective Studies
• Adult
• Middle Aged
• Bone Transplantation/methods
• Osteotomy/methods
• Young Adult
• Femur Head/surgery
• Plastic Surgery Procedures/methods

• LD22C060002 Natural Science Foundation of Zhejiang Province
• Natural Science Foundation of Zhejiang Province

• Additive manufacturing
• Hip-preserving procedure
• Osteonecrosis of femoral head
• Tantalum rod implant

• Humans
• Tantalum
• Femur Head Necrosis/surgery
• Male
• Female
• Adult
• Middle Aged
• Porosity
• Bone Transplantation/methods
• Prosthesis Design
• Finite Element Analysis
• Treatment Outcome
• Young Adult

• 2020MSXM054 Joint Project of Chongqing Science and Technology Commission
• CX2019JS202 New Technology Cultivation Project of Military Medicine

• Core decompression
• Hip arthroscopy
• Light bulb
• Necrosis of the femoral head
• Peri‐collapse

• Humans
• Retrospective Studies
• Arthroscopy/methods
• Femur Head Necrosis/surgery
• Femur Head Necrosis/diagnostic imaging
• Female
• Male
• Adult
• Decompression, Surgical/methods
• Middle Aged
• Pain Measurement

• Deep learning
• Digital radiography
• Hip preservation
• Non-vascularized fibular grafting
• Osteonecrosis of femoral head

• Humans
• Retrospective Studies
• Treatment Outcome
• Deep Learning
• Radiographic Image Enhancement
• Femur Head Necrosis/diagnosis
• Femur Head Necrosis/surgery

• CT radiomics
• Hip preservation
• Non-vascularized bone grafting
• Osteonecrosis of femoral head

• Humans
• Bone Transplantation
• Nomograms
• Postoperative Period
• Tomography, X-Ray Computed

• No. SJCX22_0769 Jiangsu Graduate Practice and Innovation Plan
• 82074471 National Natural Science Foundation of China
• No.035062005001 A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions

• Avascular necrosis of the femoral head
• Bioadaptability
• Bone regeneration
• Clinical trial
• Vascularization
• β-TCP

• National Natural Science Foundation of China

• Hip preservation
• Meta-analysis
• Non-vascularized bone graft
• Osteonecrosis of the femoral head
• Total hip arthroplasty

• AVN
• Case report
• Core decompression
• Stem cells

• Allograft
• Microsurgery
• Osteonecrosis of the femoral head
• Prognosis
• Transplantation

• AVN
• AVN, Avascular Necrosis
• DMC, Dual Mobilty Cup
• Dual mobility
• Femoral head
• ONFH, Osteonecrosis of the Femoral Head
• THA
• THA, Total Hip Arthroplasty

• core decompression
• hip-preserving procedure
• lightbulb technique
• non-vascularized bone grafting
• osteonecrosis of femoral head

• Arthroplasty, Replacement, Hip/methods
• Bone Transplantation/methods
• Femur Head/surgery
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Hip/surgery
• Humans
• Retrospective Studies
• Treatment Outcome
• Young Adult

To report the medium‐term outcomes of surgical hip dislocation (SHD) combined with impacting bone grafts and implanting iliac bone flaps in the treatment of osteonecrosis of the femoral head (ONFH) and to define the indications for this treatment.

This was a single‐center retrospective study. In total, 64 patients (70 hips) with ONFH treated from January 2014 to December 2017 were included in this study. There were 51 males and 13 females aged 18–55 years with an average age of 32 years. All patients underwent surgery for SHD combined with impacting bone grafts and implanting iliac bone flaps. Preoperative and postoperative clinical outcomes were assessed. The clinical outcome was assessed using the Harris hip score (HHS) and the conversion rate of total hip arthroplasty (THA). Univariate and multivariate logistic regression analyses were performed to identify risk factors affecting the clinical outcome. Kaplan–Meier (K‐M) analysis was applied to calculate the survival rate of the femoral head.

At the last follow‐up (60 ± 15.08 months), the HHS was excellent for 41 hips, good for 17 hips, fair for three hips, and poor for nine hips. All nine hips with poor HHS underwent THA, including five in the first 2 years following the index surgery and four between three and 5 years. The conversion rate of total hip arthroplasty was 12.86%. Univariate and multivariate logistic regression analyses showed that the duration of hip pain and JIC classification type were significantly associated with clinical outcomes. Elderly age and advanced ONFH stage tended to lead to worse surgical outcomes. The overall survival rate of JIC classification type C1 and duration of pain ≤6 months was 98.1% and 97.8% at 72 months, respectively, as estimated by the Kaplan–Meier method.

Surgical hip dislocation combined with impacting bone grafts and implanting iliac bone flaps in the treatment of ONFH had a good mid‐term clinical outcome, especially for patients with retention of the lateral column of the femoral head and hip pain less than 1 year.

• Bone grafts
• Hip preservation surgery
• Iliac bone flaps
• Osteonecrosis of the femoral head
• Surgical hip dislocation

To identify risk factors of failure after Non-Vascularized Bone Grafting (NVBG) in osteonecrosis patients, establish and validate a nomogram predictive model of hip survival after NVBG.

Data on ONFH patients undergoing NVBG at our institution between 2010 and 2017 were retrospectively collected. Preoperative risk factors potentially associated with failure after NVBG were assessed by univariate Cox regression analyses. A predictive nomogram was developed based on multivariate Cox regression model. The performance of the nomogram model was evaluated by C statistic. Subjects were stratified according to total points calculated from the nomogram and Kaplan-Meier curves were plotted to further evaluate the discrimination of the model. The model was also internally validated through calibration curves.

The overall 2-year and 5-year hip survival percentages were 91.8 and 84.6%, respectively. Age, etiology, Association Research Circulation Osseous stage and range of necrotic lesion were independent risk factors of failure after NVBG. The C statistic of the nomogram model established with these predictors was 0.77 and Kaplan-Meier curves of the tertiles showed satisfactory discrimination of the model. Internal validation by calibration curves indicated favorable consistency between actual and predicted hip survival rate.

This predictive model may be a practical tool for patient selection of NVBG. However, future studies are still needed to externally validate this model.

• Guangzhou University of Chinese Medicine
• National Natural Science Foundation of China

• Avascular necrosis
• Hip preservation
• Osteonecrosis

This study aimed to evaluate the clinical efficacy of femoral head and neck fenestration combined with autologous bone mixed with β-tricalcium phosphate porous bioceramic bone (light bulb procedure) through Orthopdische Chirurgie München approach (OCM approach) for pre-collapse non-traumatic osteonecrosis of the femoral head(ONFH).

The clinical data of 47 patients (47 hips) with ONFH were retrospectively reviewed. The Harris hip score (HHS) was used to evaluate the clinical outcomes. Imaging was assessed by X-ray. Clinical failure was defined as postoperative total hip arthroplasty (THA) or the HHS was poor (< 70). The Kaplan–Meier survival curve was used to conduct a univariate analysis of risk factors. The analysis factors included gender, age, International Association Research Circulation Osseous (ARCO) stage, etiology, body mass index (BMI), 25-hydroxyvitamin D (25(OH)D), and type I collagen carboxy-terminal peptide (CTX). The COX multivariate risk model was used to analyze the risk factors.

All the 47 hips were followed up for 24–58 months, with an average of 45 months. The Harris score (76.29 ± 10.38) at the last follow-up was significantly higher than the preoperative HHS (64.45 ± 2.93) (P < 0.05). The postoperative HHS was excellent with a success rate of 36.17%. Postoperative imaging evaluation showed that 9 hips improved, 28 hips stabilized, and 10 hips progressed. Moreover, 17 out of 47 hips were defined as a postoperative clinical failure and the success rate was 63.83%. 25(OH)D and preoperative ARCO stage were risk factors for postoperative clinical failure (P < 0.05). The COX multivariate risk model analysis showed that IIIA stage was an independent risk factor for postoperative clinical failure (P < 0.05).

The head and neck fenestration and bone grafting via the OCM approach in the treatment of non-traumatic ONFH in the pre-collapse stage can achieve good clinical outcomes. 25(OH)D deficient patients and ARCO IIIA patients had a higher failure rate of bone graft using this approach.

• Bone grafting
• Non-vascularized
• OCM approach
• Osteonecrosis of the femoral head
• Risk factors
• THA

The value of core decompression (CD) in the treatment of osteonecrosis of the femoral head (ONFH) remains controversial. We conducted a systematic review and meta-analysis to evaluate whether CD combined with other treatments could improve the clinical and radiological outcomes of ONFH patients compared with CD alone.

We searched the PubMed, Embase, Web of Science, and Cochrane Library databases until June 2020. All randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing CD alone and CD combined with other measures (CD + cell therapy, CD + bone grafting, CD + porous tantalum rod, etc.) for the treatment of ONFH were considered eligible for inclusion. The primary outcomes of interest were Harris Hip Score (HHS), ONFH stage progression, structural failure (collapse) of the femoral head, and conversion to total hip arthroplasty (THA). The pooled data were analyzed using Review Manager 5.3 software.

A total of 20 studies with 2,123 hips were included (CD alone = 768, CD combined with other treatments = 1,355). The combination of CD with other therapeutic interventions resulted in a higher HHS (mean difference (MD) = 6.46, 95% confidence interval (CI) = 2.10 to 10.83, p = 0.004) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (MD = −10.92, 95% CI = -21.41 to -4.03, p = 0.040) and a lower visual analogue scale (VAS) score (MD = −0.99, 95% CI = -1.56 to -0.42, p < 0.001) than CD alone. For the rates of disease stage progression, 91 (20%) progressed in the intervention group compared to 146 (36%) in the control group (odds ratio (OR) = 0.32, 95% CI = 0.16 to 0.64, p = 0.001). In addition, the intervention group had a more significant advantage in delaying femoral head progression to the collapsed stage (OR = 0.32, 95% CI = 0.17 to 0.61, p < 0.001) and reducing the odds of conversion to THA (OR = 0.35, 95% CI = 0.23 to 0.55, p < 0.001) compared to the control group. There were no serious adverse events in either group. Subgroup analysis showed that the addition of cell therapy significantly improved clinical and radiological outcomes compared to CD alone, and this approach appeared to be more effective than other therapies, particularly in precollapse (stage I to II) ONFH patients.

There was marked heterogeneity in the studies. There is a trend towards improved clinical outcomes with the addition of stem cell therapy to CD.

Cite this article: Bone Joint Res 2021;10(7):445–458.

• Cell therapy
• Core decompression
• Hip-preserving therapy
• Meta-analysis
• Osteonecrosis of the femoral head

• Autogenous bone grafting
• Multiple drilling
• Osteoarthritis
• Risk factors
• Total hip arthroplasty

• Bone impaction grafting
• Curved intertrochanteric varus osteotomy
• Femoral head
• Long-term outcomes
• Osteonecrosis

• Arthroplastie partielle
• Avascular necrosis
• Bone marrow
• Cellules souches
• Core decompression
• Femoral head
• Femoral osteotomy
• Forage
• Greffe osseuse non vascularisée
• Greffe osseuse vascularisée
• Hanche
• Hip
• Non vascularized
• Nécrose avasculaire
• Osteonecrosis
• Ostéonécrose
• Ostéotomie
• Partial arthroplasty
• Stem cell
• Traitement
• Treatment
• Tête fémorale
• Vascularized bone graft
• bone graft

Half of osteonecrosis of the femoral head (ONFH) patients suffer femoral head collapse at initial diagnosis, and more than half are bilaterally affected. This study developed a percutaneous autologous impaction bone graft (IBG) technique as a modification of core decompression (CD). We also summarized the short-term results and treatment efficacy of percutaneous autologous IBG in advanced ONFH.

Twenty patients (12 males, 8 females) with nontraumatic, postcollapse ONFH except one case underwent CD (10-mm core diameter) and reverse IBG. Radiological changes of the ONFH stage and type were analyzed. Survival analysis using Kaplan–Meier estimates was performed with conversion to total hip arthroplasty (THA) as the endpoint. In addition, the Harris hip score (HHS) and University of California, Los Angeles (UCLA) activity rating scale were evaluated.

Percutaneous autologous IBG was performed successfully, with an average operation time of < 1 h and small blood loss, and 7 patients (35%) needed conversion to THA at an average of 17 months postoperatively. We observed radiological progressive change in 60% of the patients during a mean observation period of 3 years. The mean clinical scores, except data recorded, after THA significantly improved (before vs. after 3 years: UCLA activity score, 3.7 vs. 5.2 [P = 0.014]; HHS, 57.6 vs. 76.5 points [P = 0.005]). In addition, 6 patients showed radiological progression but no clinical deterioration.

Percutaneous autologous IBG was technically simple and minimally invasive, but short-term results were unsatisfactory for advanced ONFH. Indications for this procedure should be carefully examined to improve it in order to enable bone formation.

• Avascular necrosis
• Bone graft
• Collapse
• Core decompression
• Femoral head
• Joint-preserving surgery
• Osteonecrosis
• Regenerative therapy
• Survivorship
• Total hip arthroplasty

• Bone transplantation
• Factor analysis
• Osteonecrosis
• Retrospective studies

The aim of the present study was to investigate clinical and radiological outcomes of autologous tricortical iliac grafting performed through a window created at the femoral head without suturing the opened articular cartilage for the treatment of osteonecrosis of the femoral head (ONFH), called modified trapdoor procedures.

A total of 59 consecutive patients (67 hips; 36 males and 23 females) with ONFH were included in this study, which was conducted from April 2009 to March 2012. Patients’ age ranged from 27 to 46 years old, with a mean age of 36.3 years. Harris hip scores (HHS) were used to evaluate hip function pre- and postoperatively. Anteroposterior and frog-position X-rays and magnetic resonance imaging (MRI) were conducted to assess lesion location, size, and ARCO stage. Clinical failure was defined as score < 80 points or treatment by total hip arthroplasty (THA). Radiographic failure was defined as a > 3 mm of collapse in the hip. This group was retrospectively matched according to the ARCO stage, extent, location, etiology of the lesion, average age, gender, and preoperative Harris hip score to a group of 59 patients (67 hips) who underwent the “light bulb” approach between March 2007 and April 2009.

Mean follow-up was 91.2 ± 13.6 months (range, 75–115 months). Mean HHS was 91.3 ± 4.5, compared with 83.1 ± 4.5 in the “light bulb” cohort at the 6-year follow-up examination (P < 0.001). At the 6-year follow-up, for modified trapdoor procedures, five hips (8.5%) were classified as clinical failure, and three hips underwent total hip arthroplasty; seven hips were classified as (10.4%) radiographic failure. The clinical and radiographic failure of the hips treated with the modified trapdoor procedure was significantly lower compared to the hips treated with the “light bulb” procedure (P < 0.05). Survival of the joint was not significantly related to the location of the femoral head lesion between two groups; however, better clinical and radiographic results were observed in modified trapdoor procedures with size C and the ARCO stage III.

The present study demonstrated superior midterm clinical results in ONFH with the use of autologous tricortical iliac block graft through a femoral head window, without suturing the opened articular cartilage. The femoral head-preserving procedure was superior compared to the “light bulb” procedure treatment in patients with postcollapse osteonecrosis and large lesion.

• Bone graft
• Cartilage
• Hip
• Osteonecrosis
• Outcome
• Surgical procedure

Non-vascularized bone grafting is a promising head-preserving technique for younger patients diagnosed as non-traumatic osteonecrosis of the femoral head (NONFH). Among the various types of bone grafting techniques, “light-bulb” procedure grafting with synthetic bone substitute is an attractive option. We aimed to assess the effectiveness of using beta-tricalcium phosphate (β-TCP) for the treatment of pre-collapse and early post-collapse lesions NONFH.

From April 2010 to June 2014, 33 patients (47 hips) with NONFH were treated using the afore-mentioned technique. The clinical and radiological outcomes were recorded and compared statistically between pre- and post-operation. Harris hip score (HHS) was used to evaluate the clinical results, and Association Research Circulation Osseous (ARCO) stage was applied to assess the radiological outcomes.

The 5-years survival rate of using β-TCP grafting was accounting for 25.5%. HHS was decreased from 78.47 to 52.87 points, and a very significant worsening of radiological results were revealed (P <  0.05). Two hips collapsed more than 2 mm were awaiting for THA, and 33 of the 47 hips had converted to THAs in an average time to failure of 24.24 months postoperatively. Meanwhile, only 4 hips survived without collapse, and 8 hips collapsed less than 2 mm. After surgery, the time onset of head collapse was 3.65 months on average, and the first conversion to THA was performed at 5 months postoperative.

Our results suggest that “light-bulb” procedure grafting with β-TCP sticks presented with a high failure rate in the early postoperative period. It is not proposed for the treatment of pre-collapse and early post-collapse lesions NONFH.

• Beta-tricalcium phosphate
• Head-preserving surgery
• Osteonecrosis of the femoral head

Porous tantalum rod implantation is a novel surgical method that is used to treat avascular necrosis (AVN) of the femoral head (hip). In the present study, the results of core decompression and tantalum rod implantation were compared with non-surgical treatment for AVN, and the survivorship of the femoral head was evaluated. In total, 60 patients with AVN femoral head were recruited and analysed. Non-surgical treatment was selected by 30 patients (41 hips), 7 with a Ficat score of I and 23 with a score of II. Non-surgical treatment included celecoxib, salvia miltiorrhiza and tetramethylypyrazine and a reduction in weight-bearing activities. Surgical treatment and porous tantalum rod implantation were selected by 30 patients (41 hips), 10 with a Ficat score of I and 20 with a score of II. After follow-up (average: 33.5 months), patients were evaluated by assessing post-operative complications, radiology, hip survivorship and Harris hip score. In the surgical group, pre-operative symptoms were significantly alleviated. No complications, including infection, delayed healing or fractures were reported. Final follow-up rates of femoral head survivorship were 4.9% in the non-surgical group and 36.7% in the surgical group. The Harris hip score was significantly improved following surgery when compared with non-surgical treatment (P<0.05). The results indicated that core decompression and porous tantalum rod implantation are beneficial short- and mid-term treatment methods for AVN of the femoral head.

• femoral head necrosis
• survival rate
• tantalum

As a pathological process, osteonecrosis of the femoral head (ONFH) is characterized by the avascularity of the femoral head, cellular necrosis, microfracture, and the collapse of the articular surface. Currently, critical treatment for early-stage ONFH is limited to core decompression. However, the efficacy of core decompression remains controversial. To improve the core decompression efficacy, regenerative techniques such as the use of platelet-rich plasma (PRP) were proposed for early-stage ONFH. As a type of autologous plasma containing concentrations of platelets greater than the baseline, PRP plays an important role in tissue repair, regeneration, and the differentiation of mesenchymal stem cells (MSCs). In this review, we present a comprehensive overview of the operation modes, mechanism, and efficacy of PRP for early-stage ONFH treatment.

We searched for relevant studies in the PubMed, Web of Science, and Embase databases. By searching these electronic databases, the identification of either clinical or experimental studies evaluating PRP, MSC, core decompression, and ONFH was our goal.

Seventeen studies of PRP and avascular necrosis of the femoral head were evaluated in our review. Ten studies related to the possible mechanism of PRP for treating ONFH were reviewed. Seven studies of the operation modes of PRP in treating ONFH were identified. We reviewed the efficacy of PRP in treating ONFH systematically and made an attempt to compare the PRP operation modes in 7 studies and other operation modes in past studies for early-stage ONFH treatment.

PRP treats ONFH mainly through three mechanisms: inducing angiogenesis and osteogenesis to accelerate bone healing, inhibiting inflammatory reactions in necrotic lesions, and preventing apoptosis induced by glucocorticoids. In addition, as an adjunctive therapy for core decompression, the use of PRP is recommended to improve the treatment of early-stage ONFH patients, especially when combined with stem cells and bone grafts, by inducing osteogenic activity and stimulating the differentiation of stem cells in necrotic lesions.

• bone graft
• light bulb
• minimally invasive
• nonvascularized
• osteonecrosis of the femoral head

Osteonecrosis of the femoral head is a poorly understood condition that may lead to progressive destruction of the hip joint. Its incidence is common between the third and fifth decades of life and it is the diagnosis behind 5–18% of annually performed total hip arthroplasties (THAs) in the USA.

Cite this article: EFORT Open Rev 2019;4:647-658. DOI: 10.1302/2058-5241.4.180073

• avascular necrosis
• core decompression
• femoral head
• hip
• osteonecrosis
• total hip arthroplasty

• Avascular necrosis of the femoral head
• collapse of the femoral head
• impacting bone graft
• surgical hip dislocation

• Bone Transplantation
• Decompression, Surgical
• Femur Head
• Femur Head Necrosis
• Hip Dislocation
• Humans
• Retrospective Studies
• Treatment Outcome

• avascular necrosis
• femoral head
• osteonecrosis

To propose a new definition of the pericollapse stage of osteonecrosis of the femoral head (ONFH) and review its significance in disease diagnosis and treatment selection.

A search for eligible studies was conducted in three electronic databases including PubMed, Cochrane Library, and Embase up to August 10, 2018, using the following keywords: “osteonecrosis”, “prognosis”, and “treatment”.

Investigations appraising the clinical signs, symptoms, and imaging manifestations in different stages of ONFH were included. Articles evaluating the prognosis of various joint-preserving procedures were also reviewed.

The pericollapse stage refers to a continuous period in the development of ONFH from the occurrence of subchondral fracture to early collapse (<2 mm), possessing specific imaging features that mainly consist of bone marrow edema and joint effusion on magnetic resonance imaging (MRI), crescent signs on X-ray films, and clinical manifestations such as the sudden worsening of hip pain. Accumulating evidence has indicated that these findings may be secondary to the changes after subchondral fractures. Of note, computed tomography provides more information for identifying possible subchondral fractures than does MRI and serves as the most sensitive tool for grading the pericollapse lesion stage. The pericollapse stage may indicate a high possibility of progressive disease but also demonstrates satisfactory long- and medium-term outcomes for joint-preserving techniques. In fact, if the articular surface subsides more than 2 mm, total hip arthroplasty is preferable.

The pericollapse stage with distinct clinical and imaging characteristics provides a last good opportunity for the use of joint-preserving techniques. It is necessary to separate the pericollapse stage as an independent state in evaluating the natural progression of ONFH and selecting an appropriate treatment regimen.

• Joint-Preserving Procedure
• Osteonecrosis of the Femoral Head
• Pericollapse
• Prognosis

• 4
• autologous graft
• bone substitute
• karyorrhexis
• percutaneous decompression
• sclerotic bone
• transillumination

• core decompression
• femoral head
• osteonecrosis
• tongluo shenggu decoction

• Adult
• Bone Transplantation/methods
• Combined Modality Therapy
• Decompression, Surgical/methods
• Drugs, Chinese Herbal/therapeutic use
• Female
• Femur Head Necrosis/drug therapy
• Femur Head Necrosis/surgery
• Humans
• Male
• Middle Aged
• Pain Measurement
• Postoperative Care
• Postoperative Period
• Retrospective Studies
• Severity of Illness Index

• Femoral head
• Lightbulb technique
• Osteonecrosis

• Avascular necrosis of femoral head
• Calcium phosphate
• Calcium sulfate
• Mini-invasive treatment
• Rehabilitation

• Adolescent
• Adult
• Alcoholism/complications
• Bone Substitutes/administration & dosage
• Bone Substitutes/adverse effects
• Bone Transplantation/adverse effects
• Bone Transplantation/methods
• Calcium Phosphates/administration & dosage
• Calcium Phosphates/adverse effects
• Calcium Sulfate/administration & dosage
• Calcium Sulfate/adverse effects
• Decompression, Surgical/adverse effects
• Decompression, Surgical/methods
• Female
• Femur Head/pathology
• Femur Head/surgery
• Femur Head Necrosis/etiology
• Femur Head Necrosis/surgery
• Glucocorticoids/adverse effects
• Humans
• Male
• Middle Aged
• Pain Measurement
• Prospective Studies
• Treatment Outcome
• Young Adult

• Bone grafting
• Gluteus medius
• Osteonecrosis

• Avascular necrosis
• Hip
• Osteonecrosis
• Review

• Hip-preservation surgery
• Osteonecrosis of the femoral head
• Peri-collapse stage

• Femur Head/surgery
• Femur Head Necrosis/surgery
• Hip/surgery
• Humans

Systemic administration of bisphosphonates has shown promising results in the treatment of osteonecrosis of the femoral head (ONFH). However, few studies have evaluated the efficacy of local zoledronate (ZOL) administration in the treatment of ONFH. The purpose of this study was to investigate whether local administration of bisphosphonate-soaked hydroxyapatite (HA) could improve bone healing in an experimental rabbit model of ONFH.

This experimental study was conducted between October 2014 and June 2015. Forty-five rabbits underwent simulated ONFH surgery. Immediately following surgery, they were divided into three groups: model (untreated, n = 15), HA (treated with HA alone, n = 15), and HA + ZOL (treated with HA soaked in a low-dose ZOL solution, n = 15). Histological, immunohistochemical, and quantitative analyses were performed to evaluate bone formation and resorption 2, 4, and 8 weeks after surgery.

Gross bone matrix and hematopoietic tissue formation were observed in the HA + ZOL group 4 weeks after surgery. The immunohistochemical staining intensities for 5-bromodeoxyuridine, runt-related transcription factor 2, osteocalcin, osteopontin, and osteoprotegerin were significantly higher in the HA + ZOL group than that in the model (P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.018, respectively) and HA groups (P = 0.003, P = 0.049, P < 0.001, P = 0.020, and P = 0.019, respectively), whereas receptor activator of the nuclear factor-κB ligand staining intensity was significantly lower in the HA + ZOL group than that in the model and HA groups (P = 0.029 and P = 0.015, respectively) 4 weeks after surgery. No significant differences in bone formation or bone resorption marker expression were found between the three groups 2 or 8 weeks after surgery (P > 0.05).

Local administration of HA soaked in a low-dose ZOL solution increased new bone formation while inhibiting bone resorption in an animal model of ONFH, which might provide new evidence for joint-preserving surgery in the treatment of ONFH.

• Adult
• Age Factors
• Bone Transplantation/methods
• Cohort Studies
• Decompression, Surgical/methods
• Female
• Femur Head Necrosis/diagnostic imaging
• Femur Head Necrosis/pathology
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Graft Survival
• Hip Joint/pathology
• Hip Joint/surgery
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Sex Factors
• Time Factors
• Tomography, X-Ray Computed/methods
• Treatment Outcome
• Young Adult

• Dual mobility
• Osteonecrosis
• Total hip arthroplasty
• Young patients

• Adult
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Female
• Femur Head/pathology
• Femur Head/surgery
• Follow-Up Studies
• Hip Dislocation/etiology
• Hip Dislocation/surgery
• Hip Prosthesis/adverse effects
• Humans
• Joint Dislocations/surgery
• Male
• Middle Aged
• Osteonecrosis/surgery
• Prosthesis Design
• Prosthesis Failure
• Reoperation
• Retrospective Studies
• Survival Rate
• Treatment Outcome

• Osteonecrosis of the femoral head
• Sartorius muscle-pedicle bone grafting

• Adult
• Arthroplasty, Replacement, Hip/adverse effects
• Bone Transplantation/methods
• Female
• Femur Head/surgery
• Femur Head Necrosis/surgery
• Follow-Up Studies
• Hip Joint/surgery
• Humans
• Male
• Middle Aged
• Muscle, Skeletal/transplantation
• Treatment Outcome

This study aimed to analyze the clinical factors related to the failure of bone grafting through a window at the femoral head-neck junction.

In total, 119 patients (158 hips) underwent bone grafting for treatment of avascular necrosis of the femoral head. The patients were classified by their ARCO staging and CJFH classification. All patients were clinically and radiographically followed up every three months during the first year and every six months in the following year. The clinical follow-up comprised determination of pre- and postoperative Harris hip scores, while serial AP, frog lateral radiographs, and CT scan were used for the radiographic follow-up.

The clinical failure of bone grafting was observed in 40 patients. The clinical failure rates in patients belonging to ARCO stage II period, IIIa, and III (b + c) were 25.9%, 16.2%, and 61.5%, respectively, while those in patients belonging to (C + M + L1) type and L2, L3 type disease groups were 1.7%, 38.9%, and 39%, respectively. The clinical failure rates in patients aged below 40 and those aged 40 and over were 20.5% and 39.0%, respectively (all P < 0.05).

Disease type, disease stage, and patient age are risk factors for failure of bone graft surgery. Patients belonging to ARCO stage II and IIIa showed a good overall response rate, while patients belonging to ARCO stage IIIb and IIIc and those with necrotic lesions involving the lateral pillar (L2 and L3 type) showed high surgical failure rates.