Surgical treatment of non-traumatic osteonecrosis of the femoral head in ARCO Ⅱ/Ⅲ stage with impaction bone grafting via femoral neck:a follow-up study over 10 years
Objective To investigate the long-term efficacy of femoral neck compression grafting for the treatment of young patients with ARCO stage Ⅱ/Ⅲ non-traumatic osteonecrosis of the femoral head(ONFH),and to analyze the main factors influencing the long-term clinical outcomes of this procedure.Methods A total of 53 patients(55 hips)with ARCO stage Ⅱ and Ⅲ ONFH who received treatment at our hospital from January 2006 to June 2012 were included in the study,comprising 49 hips in males and 6 hips in females.The age range was 18 to 59 years,with an average age of 34.5 years.All patients underwent compression grafting surgery via the femoral neck.Harris hip scores(HHS)and visual analogue scale(VAS)pain scores were compared preoperatively and at the last follow-up.Radiological changes were recorded,and the conversion rate to total hip arthroplasty(THA)was analyzed in relation to different stages and types of ONFH.Results The average follow-up duration was 12.2 years(range:10.0-14.3 years).At the last follow-up compared to preoperatively,the HHS functional score improved from(71.7±13.8)to(82.4±17.0)(P=0.000),while the VAS score decreased from(4.5±0.9)to(2.4±1.3)(P=0.000).The THA conversion rate was 25.5%(14 hips).The C2 type in the JIC classification and a combined necrotic angle of≥240° in the Kerboul classification were closely associated with the conversion to total hip arthroplasty after long-term failure(P=0.000).Conclusions Compression grafting via the femoral neck for ARCO stageⅡ and Ⅲ ONFH shows acceptable long-term clinical outcomes with a high success rate for hip preservation.The key to surgical success lies in appropriate case selection and accurate surgical technique.However,for patients with severe femoral head collapse,significant involvement of the lateral column,and larger combined necrotic angles,the success rate for hip preservation is lower,and long-term outcomes are poor,thus warranting caution when selecting femoral neck compression grafting surgery.
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