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Inverted femoral head graft versus standard core decompression in nontraumatic hip osteonecrosis at minimum 3 years follow-up

Inverted femoral head graft versus standard core decompression in nontraumatic hip osteonecrosis at minimum 3 years follow-up

Hip Int 2017; 27(1): 74 - 81

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/hipint.5000426

Authors

Asser A. Sallam, Mohamed A. Imam, Khaled S. Salama, Osman A. Mohamed

Abstract

Purpose

Numerous salvage surgeries were popularised to halt the progression of hip osteonecrosis (ON). We aimed to compare the clinico-radiological outcomes of inverted femoral head graft (IFHG) versus standard core decompression (SCD) in treatment of nontraumatic hip ON at pre-arthritic stage.

Methods

A case review was performed at a minimum 3 years follow-up of 61 patients (71 hips; mean age 32.96 (19-50) years; mean follow-up 7.86 (3-14) years; mean body mass index 28.58 (19-46); 32 males, 29 females) suffering nontraumatic hip ON at pre-arthritic stage. 38 hips underwent SCD and 33 IFHG. The outcome was assessed by changes in modified Harris Hip Score (MHHS), need for revision surgery and progression of modified Ficat-Arlet staging. Data were analysed including logistic regression and Kaplan-Meier survivorship analysis.

Results

13/34 (38.2%) hips in SCD group were revised at 4.61 ± 2.61 years, while 7/33 (21.2%) in IFHG group at 8.43 ± 4.32 years (p = 0.023). MHHS was significantly higher in IFHG group at 1 and 3 years as well as at last follow-up (p = 0.014, 0.001 and 0.023 respectively). Clinical and radiological significant differences were found in survivorship analysis between both groups, in favor of IFHG. A higher clinical failure was noted among obese patients.

Conclusions

An IFHG technique offers a better alternative regarding postoperative clinico-radiological outcomes in nontraumatic hip ON at the pre-arthritic stage. A cautious prognosis is recommended in obese patients.

Article History

Disclosures

Financial support: None.
Conflict of interest: None.

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Authors

Affiliations

  • Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia - Egypt
  • Department of Orthopaedic Surgery, Al-Azhar University Hospital, Damietta - Egypt

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