Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head

摘要

Osteonecrosis of the femoral head is a progressive disease. Without operative intervention, it most often results in collapse and deterioration of the joint. Many joint-preserving surgeries have been implemented, but no uniform treatment exists. The authors report a modified technique of tantalum rod implantation combined with vascularized iliac grafting for the treatment of osteonecrosis of the femoral head. Fifty-two patients (56 hips) with osteonecrosis of the femoral head (Association Research Circulation Osseous classification stage II-IV) treated with this technique were retrospectively reviewed. The major steps of this technique included vascularized iliac graft harvested, necrotic lesion excised, and combined interventions implantation. All patients were followed for a mean of 60 months. Seven hips had to be converted to a total hip arthroplasty. The 5-year joint-preserving success rate of entire group was 87.5%, with 95% for Association Research Circulation Osseous stage II hips, 92% for Association Research Circulation Osseous stage III hips, and 63.6% for Association Research Circulation Osseous stage IV hips. The success rate was lower for stage IV hips compared with stage II and III hips. Mean Harris Hip score of the 49 hips improved significantly from 50 to 91 points. Forty-three (76.8%) of 56 hips remained stable on radiographs. The technique of tantalum rod implantation combined with vascularized iliac grafting may be an effective joint-preserving method for the treatment of intermediate-stage osteonecrosis of the femoral head. A larger group of patients that is compared with a control group is necessary to further research.