Clinical outcome and influencing factors of surgical hip dislocation combined with iliac bone flaps implanting in the treatment of non-traumaticosteo necrosis of the femoral head
Objective To investigate the medium-term outcomes of surgical hip dislocation(SHD)combined with impacted bone grafts and iliac bone flap implantation in the treatment of non-traumatic osteonecrosis of the femoral head(NONFH)and to define the indications for this treatment.Methods A total of 56 cases(62 hips)with non-traumatic osteonecrosis of the femoral head from January 2014 to December 2017 were included in this study.According to the JIC classification,47 hips were classified as JIC type C1,and 15 hips were classified as JIC type C2 at initial diagnosis.All patients underwent SHD surgery combined with impacted bone grafts and iliac bone flap implantation.Preoperative and postoperative clinical outcomes were assessed using the Harris hip score(HHS)to evaluate hip function before and after the operation in all patients.The excellent and good hip function ratio and X-ray imaging evaluation were used as the evaluation indexes of curative effect.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.Results At the last follow-up(59.58±15.06 months),the HHS was 87.50±11.84,which was significantly higher than that before the operation 55.58±8.43.The HHS was excellent for 34 hips,good for 14 hips,fair for 1 hip,and poor for 9 hips.The rate of excellent and good hip function was 83.87%.All nine hips with poor HHS underwent total hip arthroplasty(THA)within 4 years.The collapse situation,according to X-ray,recovered in 14 hips(22.58%),did not progress in 5 hips(8.06%),and developed in 39 hips(62.90%).JIC type C1 and pain duration≤12 months were found to protect patients from THA.There were statistical differences in the survival curves of the C1 and C2 groups of JIC classification(P<0.001),and there were statistical differences in the survival curves of the three groups with pain duration≤6 months,7-12 months,and>12 months(P<0.001).The overall survival rates of JIC type C1 and C2 were 97.9%and 46.5%,respectively.The overall survival rates of patients with pain duration≤6 months,7-12 months,and>12 months were 97.5%,92.9%,and 12.5%,respectively.Conclusions SHD combined with impacted bone grafts and iliac bone flap implantation in the treatment of NONFH had good short-term and mid-term clinical outcomes,especially for patients with retention of the lateral column of the femoral head and hip pain less than 1 year.
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