多孔重建钽棒内固定治疗早期股骨头坏死疗效观察与分析

目的探讨多孔金属钽棒在早期股骨头坏死治疗中的应用,评价其临床效果,分析失败病例。方法对17例(23髋)早期股骨头坏死(SteinbergⅠ、Ⅱ期)采用髓芯减压联合多孔重建钽棒内固定治疗,以髋关节Harris评分及影像学进行临床疗效评估。结果本组均获9～39个月随访,平均22个月。切口均一期愈合;3例(4髋)在术后随访期内股骨头坏死进展发生塌陷,其中2例(3髋)行全髋关节置换手术,1例行非手术治疗;末次随访Harris评分优良率78.3%。结论股骨头坏死髓芯减压联合重建钽棒内固定术对早期股骨头坏死(SteinbergⅠ、Ⅱ期)的治疗效果是比较满意的,但对疼痛明显的患者应慎用。     

钽棒治疗早期股骨头坏死的中远期疗效分析

背景：多孔钽金属棒的研制与临床应用,为行保留股骨头手术提供了新的思路和方法。目前对于该术式的早期疗效比较肯定,尚缺乏中远期的随访。目的：探讨应用钽棒治疗早期股骨头坏死的中远期临床疗效。方法：2008年5月至2011年5月运用钽棒治疗早期股骨头坏死患者65例80髋,评估手术前、术后3个月及末次随访的Harris评分,末次随访的股骨头生存率。结果：全部获得随访,随访时间为36-60个月,平均48个月。股骨头生存率可达90%,其中SteinbergⅠ期生存率100%,Ⅱ期生存率95%,ⅢA期生存率73%。8例术后6-8个月出现股骨头塌陷,其余各髋未见进一步塌陷,末次随访X线片示假体位置良好。结论：钽棒植入术是治疗早期股骨头坏死的有效手段,其中远期疗效满意。     

钽棒治疗早期非创伤性股骨头坏死的回归性研究

[目的]分析钽棒治疗早期股骨头坏死的临床疗效,探讨影响钽棒治疗早期股骨头坏死临床疗效的因素.[方法]钽棒治疗早期股骨头坏死病例149例(168髋),男96例,女53例;平均年龄32.36岁.Ⅰ期和Ⅱ期(塌陷前)88髋,Ⅲ期(塌陷后)80髋,其中双侧19例.根据ARCO分期,进行Harris评分和影像学评估.将Harris评分70分以下、再次手术、影像学病变进展(股骨头由非塌陷变塌陷或塌陷加重,关节间隙狭窄加重)视为钽棒失败.[结果]共随访到130例138髋,平均随访时间(31.47±5.78)(8～61)个月,术前平均Harris评分为62.65,术后为79.50(P<0.05).优良率为68.12%.Cox风险模型分析显示大病灶、外侧病灶、植骨与否是手术失败的风险因素,病因、性别、年龄、病灶是否在股骨头骺板内,对钽棒治疗早期股骨头坏死的临床疗效无明显影响.[结论]影响钽棒治疗早期股骨头坏死临床疗效的因素是病灶大小(大于30%)、坏死灶位置(外侧型)、植骨与否,钽棒治疗早期股骨头坏死需要清除死骨、联合植骨.     

钽棒联合富集骨髓干细胞治疗早期股骨头坏死的近期疗效

目的观察钽棒联合富集骨髓干细胞治疗早期股骨头坏死临床疗效。方法选取2008年1月至2010年7月期间符合ARCO分期早期标准的患者共22例（35髋）,ⅠB期6髋,ⅠC期10髋、ⅡA期4髋,ⅡB期7髋,ⅡC期7髋,ⅢA期1髋,采用骨髓血采集,骨髓干细胞富集,干细胞移植联合钽棒植入治疗。随诊观察患髋疼痛缓解程度,手术前后Harris评分和影像学进展情况。结果 19例（31髋）患者获2年以上（25～54个月,平均37个月）的随访。（1）髋关节功能行Harris评分：由术前（76.92±9.11）分升至术后（89.09±8.21）分,两组比较有统计学差异（t=7.160,P〈0.01）;（2）髋关节影像学检查：术后继续塌陷ⅠC期1髋,ⅡB期1髋,ⅡC期1髋,最终行全髋关节置换,术后随访25个月的生存率为90.32%。MRI测得股骨头坏死表面积比,由术前的（31.89%±7.95%）降至术后的（11.20%±5.69%）,两组比较有统计学差异（t=-11.494,P〈0.01）。结论钽棒联合富集骨髓干细胞治疗早期股骨头坏死近期疗效肯定,远期疗效有待进一步观察。     

钽棒置入联合外周血干细胞介入治疗早期股骨头坏死

目的评估钽棒置入联合外周血干细胞介入治疗早期股骨头坏死(ON)的临床疗效。方法笔者自2009-01—2011-08采用钽棒置入治疗28例(43髋)ON,并于钽棒置入1~2周后进行了外周血干细胞介入,部分患者4~6周后接受第2次细胞疗法。结果 27例(42髋)获得平均48(36~60)个月随访,1例(1髋)失访,无一例死亡。术后36个月时股骨头的生存率为91.7%,HHS评分从术前的(56.3±12.8)分改善为术后的(90.5±19.3)分,差异有统计学意义(t=9.224,P0.001)。39髋HHS评分优26髋,良10髋,可3髋,优良率92.3%。第2次介入发现股骨头内血管数目增多,血管变粗。术后1例发生大粗隆部位的滑囊炎,未发生其他术后并发症。结论钽棒置入联合外周血干细胞介入治疗早期股骨头坏死可以有效缓解疼痛,改善髋关节功能、避免或者延迟关节置换手术,应用前景广阔。     

多孔钽棒植入治疗股骨头坏死的适应证及临床疗效观察

目的探讨多孔钽棒植入治疗股骨头坏死的适应证并观察其临床疗效。方法2008年5月至2008年11月,治疗股骨头坏死患者25例29髋,男14例17髋,女11例12髋;年龄29—48岁,平均36岁;根据Steinberg分期：Ⅰ期10髋,Ⅱ期16髋,Ⅲ期3髋。采用侧方小切口入路,行髓心减压及多孔钽棒植入术。术后3周内禁止负重,3周后可部分负重,然后逐步过渡至完全负重。采用Harris评分系统评估术后患髋功能的改善情况;术后3、6、12个月摄正、侧位x线片,观察股骨头修复情况及有无坏死进展。结果23例27髋获得随访,随访时间12—18个月,平均15个月。术后12个月或末次随访进行疗效评估,优：17例19髋,良：4例5髋,可：2例3髋。患者的Harris评分由术前的49～83分,平均（65．3±8．6）分,提高至术后的75～100分,平均（88．2±9．3）分（P〈0．001）。Ⅰ期由术前70～83分,平均（73．7±5．6）分,提高至术后79～100分,平均（94．5±6．4）分;Ⅱ期由术前51～72分,平均（63．4±6．1）分,提高至术后76—99分,平均（87．1±9．0）分;Ⅲ期由术前49—65分,平均（56．8±7．3）分,提高至术后74—89分,平均（81．7±8．2）分。各组提高分数之间显著差异。髋关节影像学表现稳定,股骨头无坏死进展。结论髓心减压及多孔钽棒植入术治疗股骨头缺血性坏死适合于SteinbergⅠ、Ⅱ期及较小塌陷的Ⅲ期股骨头坏死患者。     

钽棒置入联合自体红骨髓移植治疗早期股骨头坏死的近期临床疗效

目的比较分析多孔钽棒置入和多孔钽棒置入联合自体红骨髓移植术治疗早期股骨头坏死的近期疗效。方法32例（38髋）早期股骨头坏死分为2组,其中钽棒置入（对照组）治疗16例（18髋）,钽棒置入联合自体红骨髓移植（实验组）治疗16例（20髋）。根据髋关节功能Harris评分比较2组临床疗效。结果术后3、6、12个月2组Harris评分均较术前明显提高,且实验组均较对照组高,差异有统计学意义（P〈0.05）。结论钽棒置入联合红骨髓移植治疗早期股骨头坏死较单纯钽棒置入可提高患者的髋关节功能,值得临床推广应用。     

股骨头坏死钽棒植入后中期随访失败原因分析

目的评估钽金属棒治疗股骨头缺血性坏死后的生存率并评价其临床效果和影像学结果,分析其转归至全髋关节置换术(THA)的原因。方法回顾性分析2008年6月至2013年12月于中日友好医院骨坏死与关节保留重建中心因股骨头缺血性坏死行钽金属棒联合自体骨植入的101例患者(117髋)进行评价。纳入标准:非创伤性股骨头缺血性坏死。排除标准:存在手术禁忌、先前接受过任何其他类型治疗的病例、髋关节继发骨关节炎病例。根据国际骨循环协会(ARCO)分期,Ⅱ期49髋,Ⅲ期68髋;根据中日友好医院(CJFH)分型,L1型15髋,L2型59髋,L3型40髋,C型3髋。应用SPSS 19.0软件进行统计学分析。采用t检验或单因素方差分析进行手术前后及术后各组间髋关节Harris评分比较。采用分类变量的2检验或Fisher精确检验对影响影像学进展及转归至THA的因素进行分析。对性别、年龄、体重指数、有无骨髓水肿、单双侧、病因、ARCO分期、CJFH分型等因素使用Cox比例风险模型进行多变量分析以确定造成转归至THA和影像学进展的独立危险因素。结果最终90例患者(104髋)获得随访,平均随访时间为(46±21)个月,平均年龄为(39±8)岁。终末随访时,Harris评分自术前(76±13)分降至术后(69±15)分,组间差异有统计学意义(t=3.939,P0.01),最终49髋转归至THA,根据多因素Cox风险比列模型分析年龄,CJFH分型和ARCO分期是全髋关节置换和影像学进展的独立危险因素。结论钽金属棒治疗股骨头缺血性坏死的临床效果欠佳,影响其临床结局的因素包括年龄(40岁),CJFH分型(L3型),ARCO分期(Ⅲ期),应严格把握该手术适应证。     

微创置入陶瓷棒联合口服益肾消痛丸治疗早中期股骨头坏死的临床研究

目的探讨微创置入陶瓷棒联合口服益肾消痛丸治疗早中期股骨头坏死的近期疗效。方法纳入自2014-10—2016-06在河南省中医院关节科诊治的42例(45髋)股骨头坏死,观察组21例(22髋)采用微创置入陶瓷棒联合口服益肾消痛丸治疗,对照组21例(23髋)单纯行微创陶瓷棒置入术。结果 42例均获得18个月随访。术后6个月X线片显示陶瓷棒已部分降解,观察组19髋、对照组13髋股骨头内可见新骨矿化影,观察组3髋、对照组10髋股骨头坏死未修复;观察组股骨头坏死修复程度优于对照组,差异有统计学意义(P0.05)。术后18个月X线片显示32髋股骨头坏死修复者股骨头形态完好,无塌陷,新骨进一步矿化;观察组1髋、对照组3髋股骨头塌陷,行人工髋关节置换术。观察组术后3、6、18个月髋关节功能Harris评分均高于对照组,差异有统计学意义(P0.05)。结论微创置入陶瓷棒在短期内可有效阻止ARCOⅠ、Ⅱ期股骨头坏死进展,缓解症状,配合口服中药益肾消痛丸,能够改善微循环,促进血管再生。     

钽棒和缝匠肌骨瓣植入分期治疗早期股骨头坏死疗效观察

目的:观察钽棒和缝匠肌骨瓣植入分期治疗早期股骨头坏死的临床疗效。方法:选取股骨头坏死患者124例(215髋),按照ARCO分期,分别给予缝匠肌骨瓣植入(ARCOⅠC期、Ⅱ期、ⅢA期)或者钽棒植入(ARCOⅠA、B期)治疗;术后均顺利完成2年的随访,结合影像学表现并根据Harris髋关节功能评分标准进行临床评价,术后6个月、1年及2年进行统计分析。结果:术后6个月、1年及2年两种方案的Harris评分为:钽棒植入(78.64±2.60)分、(83.82±4.63)分、(90.21±3.29)分,缝匠肌骨瓣植入(63.84±8.32)分、(81.66±6.08)分、(85.90±5.61)分。与治疗前比较,差异均有统计学意义(P0.05)。结论:分别针对ARCOⅠ、Ⅱ期及ⅢA期患者,采取针对性手术保髋治疗青壮年早期股骨头坏死疗效确切,可明显改善患者的生活质量。     

病灶清除后打压植骨联合多孔钽金属棒植入治疗早期股骨头缺血性坏死

目的探讨病灶清除后打压植骨联合多孔钽金属棒植入治疗早期股骨头缺血性坏死的临床疗效。方法 2008年3月-2010年5月,收治14例16髋股骨头缺血性坏死患者。男13例15髋,女1例1髋;年龄18～73岁,中位年龄42.2岁。外伤性1例1髋,酒精性4例4髋,激素性9例11髋。股骨头缺血性坏死根据国际骨循环研究会(ARCO)分期:Ⅰ期3髋,Ⅱ期13髋。Harris评分为(51.89±12.42)分,采用中华医学会骨科学分会百分比评价法中的X线评价方法评分为(31.88±4.03)分。病程6个月～7年,中位病程2.5年。采用经股骨头颈部开窗、病灶清除、自体髂骨打压植骨联合多孔钽金属棒植入治疗。术后患肢避免负重3个月,部分负重3个月。结果术后切口均Ⅰ期愈合,无感染等早期并发症发生。患者均获随访,随访时间13～36个月,平均24个月。2例2髋因关节疼痛加重、股骨头塌陷,于术后4个月及2年行人工全髋关节置换;其余患者术后关节疼痛症状均明显缓解,股骨头生存率为87.5%(14/16)。髋关节功能行Harris评分为(84.89±17.96)分,与术前比较差异有统计学意义(t=—8.038,P=0.001)。X线片检查示植骨区域成骨化明显,骨密度增高,骨小梁排列整齐规则,股骨头无明显塌陷。末次随访时X线片评分为(32.19±6.57)分,与术前比较差异无统计学意义(t=—2.237,P=0.819)。结论病灶彻底清除后打压植骨联合多孔钽金属棒植入治疗早期股骨头缺血性坏死能有效缓解疼痛、改善髋关节功能、防止股骨头塌陷,延缓甚至避免人工全髋关节置换。     

Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis

Background and purpose Tantalum rod implantation has recently been proposed for treatment of early stages of femoral head osteonecrosis. The purpose of our study was to report the early results of its use in pre- and post-collapse stages of the disease.

Methods We studied prospectively 27 patients who underwent tantalum rod implantation for treatment of nontraumatic femoral head osteonecrosis between December 2000 and September 2005. Patients were evaluated radiologically and clinically using the Steinberg classification and the Harris hip score (HHS). Disease stage varied between stages II and IV. Mean follow-up time was 38 (15–71) months.

Results 1 patient (1 hip) died 15 months after surgery for reasons unrelated to it. 13 of 26 hips remained at the same radiographic stage, and 13 deteriorated. Mean HHS improved from 49 to 85. 6 patients required conversion to total hip arthroplasty. When the procedure was used for stages III and IV, both radiological outcome and revision rates were worse than for the stage II hips. There was, however, no difference in postoperative HHS between patients at pre- and post-collapse stages at the time of initial evaluation. Survivorship, with revision to THA as the endpoint, was 70% at 6 years.

Interpretation The disease process does not appear to be interrupted, but there was a significant improvement in hip function initially in most hips. Tantalum rod implantation is a safe “buy-time” technique, especially when other joint salvage procedures are not an option. Appropriate patient selection and careful rod insertion are needed for favorable results.     

多孔钽金属棒治疗股骨头坏死的短期临床疗效

目的探讨多孔钽金属棒治疗股骨头坏死的短期临床疗效。方法从2008年8月至2009年12月,使用多孔钽金属棒植入治疗股骨头坏死26例共33髋,男14例18髋,女12例15髋。根据Steinberg分期：Ⅱ期15髋、Ⅲ期16髋和Ⅳ期2髋。术中经外侧小切口行髓芯减压,必要时在坏死腔中置入不规则颗粒人工骨,最后植入多孔钽金属棒。术后禁止负重4周后开始部分负重4周,随后逐渐过渡到完全负重。定期随访X线及Harris评分,评估术后患髋功能的改善情况。结果所有26例共33髋全部获得随访。平均随访24.2（20.0～30.5）个月。术后末次随访Harris评分为（85.7±7.9）分,较术前（65.9±10.1分）改善为19.8分（P〈0.05）。关节功能优11髋（33.3%）,良16髋（48.5%）,可4髋（12.1%）,差2髋（6.0%）。仅1髋术后2年出现关节面塌陷,余各假体位置良好,股骨头无进一步塌陷。结论多孔钽金属棒为股骨头坏死患者（Ⅲ期前及ⅢA期）提供了一种新的治疗选择。     

Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years

Background and purpose Tantalum rod implantation has recently been proposed for treatment of early stages of femoral head osteonecrosis. The purpose of our study was to report the early results of its use in pre- and post-collapse stages of the disease.Methods We studied prospectively 27 patients who underwent tantalum rod implantation for treatment of nontraumatic femoral head osteonecrosis between December 2000 and September 2005. Patients were evaluated radiologically and clinically using the Steinberg classification and the Harris hip score (HHS). Disease stage varied between stages II and IV. Mean follow-up time was 38 (15–71) months.Results 1 patient (1 hip) died 15 months after surgery for reasons unrelated to it. 13 of 26 hips remained at the same radiographic stage, and 13 deteriorated. Mean HHS improved from 49 to 85. 6 patients required conversion to total hip arthroplasty. When the procedure was used for stages III and IV, both radiological outcome and revision rates were worse than for the stage II hips. There was, however, no difference in postoperative HHS between patients at pre- and post-collapse stages at the time of initial evaluation. Survivorship, with revision to THA as the endpoint, was 70% at 6 years.Interpretation The disease process does not appear to be interrupted, but there was a significant improvement in hip function initially in most hips. Tantalum rod implantation is a safe “buy-time” technique, especially when other joint salvage procedures are not an option. Appropriate patient selection and careful rod insertion are needed for favorable results.     

髋臼骨折内固定失败术后的全髋关节置换术

目的:探讨髋臼骨折内固定失败术后继发创伤性关节炎和(或)股骨头缺血性坏死行全髋关节置换术的特点及临床疗效。方法:2009年2月至2014年10月,采用全髋关节置换术对31例(31髋)髋臼骨折内固定失败继发创伤性关节炎和(或)股骨头缺血性坏死患者进行治疗,其中男26例,女5例;受伤时平均年龄(41±12)岁。患者因髋臼骨折内固定术后3~132个月,平均(20.6±26.9)个月内继发创伤性关节炎和(或)股骨头缺血性坏死而行全髋关节置换术,全髋关节置换术均采用后外侧入路。观察术后并发症和关节活动度,并比较术前和术后随访时髋关节VAS疼痛评分和Harris髋关节评分。结果:术后27例获得随访,随访时间12~80个月,平均(43.2±11.7)个月。其中出现关节感染1例,假体松动1例,脱位1例,无继发坐骨神经损伤病例发生。所有随访病例髋关节功能和步态有明显改善;至末次随访时,VAS由术前平均(7.6±1.2)分,降低到术后平均(1.2±0.9)分,Harris评分由术前平均(45.5±13.6)分,提高到术后平均(88.5±7.8)分,差异均有统计学意义(P0.01)。髋关节除后伸外,前屈、外展、内收、内旋及外旋活动范围较术前显著增加,差异有统计学意义(P0.05)。X线片复查示:髋臼假体无不稳定发生,1例股骨柄假体下沉3 mm,2例发生异位骨化。结论:正确处理内固定物,提防潜在感染,合理重建髋臼骨缺损,是髋臼骨折内固定失败术后全髋关节置换成功的关键。     

Arthroskopisch gestützte Behandlung der aseptischen Hüftkopfnekrose

Objective

Preservation of the hip joint function by treatment of the avascular necrosis of the femoral head in adults or at least avoiding progression.

Indications

Avascular necrosis of the femoral head in adults in Steinberg stages I–III. In patients with Steinberg stage IVa (subchondral collapse ≤?15% of the articular surface, depression <?2 mm) hip joint salvage therapy in early stages of femoral head collapse.

Contraindications

Manifest osteoarthritis of the hip joint. Joint infection. Relative contraindications: subchondral collapse >?15% of the articular surface or depression >?2 mm (Steinberg stage IVb and above). Persisting risk factors for a progression of avascular necrosis (e.g., alcohol abuse, chemotherapy, local irradiation, high-dose cortisone therapy) and obesity (BMI >?40).

Surgical technique

Arthroscopy of the hip joint in case of cartilage defects and/or potential collapse of the femoral head. Without collapse of the femoral head and absence of severe damage of the cartilage: core decompression using a guiding sleeve through a lateral approach (Steinberg II, III). Subsequently curettage of the necrotic area through a central drill hole and insertion of autogenic bone cylinders using an OATS harvester (Steinberg II b/c, III b/c). In Steinberg stage IVa, reconstruction of the outline of the femoral head is attempted by reduction of the impressed portion (under intraoperative fluoroscopy).

Postoperative management

Limited weight bearing (10 kg) of the operated leg for 6 weeks. In cases of large necrotic defects located directly beneath the subchondral bone (Steinberg IIIc) as well as subchondral collapse with flattening of the femoral head (Steinberg IVa) limited weight bearing (10 kg) for 12 weeks.

Results

Early results of femoral head preserving therapy in 53 patients (56 hips, consecutively treated between June 2004 and December 2009) after 33?±?20 months: success rate (no arthroplasty, no reoperation, no radiological progress associated with clinical symptoms) 86% for patients treated with Steinberg stages I–III. Failure of the head preserving therapy with concern to the mentioned criteria depending on the initial Steinberg stage: 0 (0%) for stage I, 2 (10%) for stage II, 3 (25%) for stage III, and 4 (31%) for stage IVa.     

全髋表面置换术治疗股骨头坏死短期随访研究

目的：研究全髋表面置换术治疗股骨头坏死的短期疗效,探讨表面置换术治疗股骨头坏死技术要求和手术指征。方法：对2006年12月至2009年12月37例（43髋）行全髋表面置换术的股骨头缺血坏死患者进行随访,男25例,女12例;年龄21～67岁,平均44.5岁。按照ARCO进行分期：3A期3髋,3B期6髋,3C期16髋,4期18髋。根据Harris评分系统对手术前后关节疼痛、活动度、畸形矫正及功能的改善进行对比,用Charnley法比较术后假体松动X线改变。结果：失访3例,34例（40髋）获得随访,37髋疼痛完全缓解,3髋行走后有酸痛不适。随访时间16～53个月,平均32.4个月。术前Harris平均评分（51.5±1.7）分,术后32.4个月平均（94.3±1.4）分,较术前提高。优37髋,良3髋,差0髋。34例都恢复了正常生活或工作,术后疼痛明显缓解,其中3例（髋）长距离行走后有轻度酸痛不适,休息后缓解。1例异位骨化BrookerⅢ型,无疼痛,不影响正常行走和生活。无术后股骨颈骨折,无脱位,无松动和翻修。结论：经过适当患者选择、术中的精细操作,全髋表面置换术治疗股骨头缺血坏死可以获得满意的短期疗效。     

钽棒植入联合带血管蒂髂骨瓣转移治疗中青年早期股骨头坏死

目的探讨钽棒植入联合带血管蒂髂骨瓣转移治疗中青年早期股骨头坏死的临床疗效。方法回顾性分析2007年10月至2012年1月中山大学附属江门医院采用钽棒植入联合带血管蒂髂骨瓣转移治疗的11例（15髋）中青年早期股骨头坏死患者的临床资料,记录手术时间、术中出血量,观察内置钽棒松动、断裂及症状改善情况,末次随访时进行髋关节Harris评分和影像学检查。结果11例患者随访12~60个月（平均24个月）。手术时间60～100min（平均70min）、术中出血量200~400mL（平均280mL）。随访期间内置钽棒未见松动、断裂,未出现钽棒排斥反应。患髋疼痛感减轻或消失,末次随访时Harris评分为（85士4）分,较术前的（62士3）分明显提高（f=6．505,P=O．000）。影像学检查未见股骨头塌陷,植骨区域未出现骨坏死趋势。结论钽棒植入联合带血管蒂髂骨瓣转移手术可改善血供,提供足够的力学支持,有效防止股骨头进一步塌陷,临床功能改善效果较理想,是治疗中青年早期股骨头坏死的有效方法。     

Tantalum rod implantation for femoral head osteonecrosis: survivorship analysis and determination of prognostic factors for total hip arthroplasty

Purpose

The purpose of this study was to evaluate the moderate survival data of porous tantalum rod implants for the treatment of osteonecrosis of the femoral head (ONFH). Additionally, some independent prognostic factors for conversion to total hip arthroplasty (THA) were identified.

Methods

The porous tantalum rod population was obtained from a prospective, consecutive group of patients treated for Steinberg stage I and II osteonecrosis from April 2009 through July 2011. The historical core decompression and impaction of bone filling particle subjects underwent surgery from April 2007 through March 2009. Surgical data including time of surgery, blood loss, and cell transfusions were recorded. Post-operative values were measured for hospitalization length as well as days requiring a patient-controlled analgesia (PCA) pump. Primary outcomes were Harris hip score and survivorship analysis. Demographics and baseline characteristics included age, sex, etiology, bilateral disease, associated chronic systemic disease, Steinberg stage, Harris hip score, accompanied with bone marrow edema of femoral head, and osteonecrotic lesion size.

Results

Demographic/baseline characteristics were similar between two groups. At the post-operative follow-up of 62 months, Harris hip scores were significantly increased (P?<?0.0001) when compared to that before surgery in both groups. The magnitude of increase in the tantalum rod implant group was significantly greater than that in the control group (P?=?0.0426). With an average follow-up of 48 months (range, 38–62 months), the tantalum rod group had an 84.6 % survival rate. With an average follow-up of 72 months (range, 67–85 months), the control group had a 63.3 % survival rate. A comparison of Kaplan-Meier curves showed significantly higher cumulative survival rates (P?=?0.048) for hips with implantation of the porous tantalum rod (74.1 % at 62 months) than for those with impaction composite bone material (49.9 % at 62 months). The Cox proportional-hazard model revealed that implantation of tantalum rod (P?=?0.012), bone marrow edema (P?=?0.003), corticosteroids intake (P?=?0.007), and age less than 50 years (P?=?0.014) were the independent prognostic factors related to conversion into THA.

Conclusions

Compared with the traditional impaction composite bone material technique, implantation of tantalum rod in the treatment of Steinberg stages I and II ONFH can obtain better clinical results and higher cumulative survival rates. For patients without the use of corticosteroids, and especially for hips without bone marrow oedema, the clinical results from our study show highly encouraging survival rates and a delay in or prevention of conversion into THA.