Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up
Background: Osteonecrosis of the femoral head can lead to destruction of the hip joint and disabling arthritis in young adults, if left untreated. Among the salvage procedures, core decompression combined with bone graft substitutes is a viable option for joint preservation. The purpose of this stud...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2015-06-01
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| Series: | Biomedical Journal |
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| Online Access: | http://www.biomedj.org/article.asp?issn=2319-4170;year=2015;volume=38;issue=3;spage=257;epage=261;aulast=Yu |
| _version_ | 1811182740168507392 |
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| author | Pei-An Yu Kuo-Ti Peng Tsan-Weng Huang Robert Wen-Wei Hsu Wei-Hsiu Hsu Mel S Lee |
| author_facet | Pei-An Yu Kuo-Ti Peng Tsan-Weng Huang Robert Wen-Wei Hsu Wei-Hsiu Hsu Mel S Lee |
| author_sort | Pei-An Yu |
| collection | DOAJ |
| description | Background: Osteonecrosis of the femoral head can lead to destruction of the hip joint and disabling arthritis in young adults, if left untreated. Among the salvage procedures, core decompression combined with bone graft substitutes is a viable option for joint preservation. The purpose of this study was to review the outcomes of using synthetic bone graft substitute (calcium sulfate and calcium phosphate) for the treatment of late-stage osteonecrosis of the femoral head.
Methods: From November 2008 to May 2009, 19 hips in 18 patients with osteonecrosis of the femoral head [6 hips in Association Research Circulation Osseous (ARCO) stage IIC and 13 hips in stage IIIA] were treated with core decompression combined with PRO-DENSE™ (Injectable Regenerative Graft). The average age of the patients at the time of surgery was 48 years (range 25-67 years). Twelve patients (13 hips) overused alcohol, four patients (4 hips) were idiopathic, one patient (1 hip) used corticosteroids, and one patient (1 hip) was post-traumatic. The clinical failure was defined as conversion to total hip arthroplasty or progression in head collapse.
Results: At the conclusion of the study, 3 in the 6 stage IIC hips and 8 in the 13 stage IIIA hips were converted to total hip arthroplasty in an average of 8.5 months (range 4-30 months) postoperatively. Advanced collapse of the femoral head awaiting for total hip arthroplasty was observed in the other six hips. Of the 19 hips, only 2 hips (10.5%) survived without further collapse in the 5-year follow-up. This resulted in 89.5% failure rate with early resorption of the grafting in an average of 5.3 months.
Conclusions: Core decompression combined with an injectable calcium sulfate and calcium phosphate composite graft (PRO-DENSE) were associated high failure rates in the early postoperative period. It is not recommended for the treatment of ARCO stage IIC and IIIA osteonecrosis of the femoral head. |
| first_indexed | 2024-04-11T09:36:54Z |
| format | Article |
| id | doaj.art-aa5bc32b1ac84d97a4bac5510315c4c4 |
| institution | Directory Open Access Journal |
| issn | 2319-4170 2320-2890 |
| language | English |
| last_indexed | 2024-04-11T09:36:54Z |
| publishDate | 2015-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Biomedical Journal |
| spelling | doaj.art-aa5bc32b1ac84d97a4bac5510315c4c42022-12-22T04:31:35ZengElsevierBiomedical Journal2319-41702320-28902015-06-0138325726110.4103/2319-4170.138307Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-upPei-An Yu Kuo-Ti Peng Tsan-Weng Huang Robert Wen-Wei Hsu Wei-Hsiu Hsu Mel S LeeBackground: Osteonecrosis of the femoral head can lead to destruction of the hip joint and disabling arthritis in young adults, if left untreated. Among the salvage procedures, core decompression combined with bone graft substitutes is a viable option for joint preservation. The purpose of this study was to review the outcomes of using synthetic bone graft substitute (calcium sulfate and calcium phosphate) for the treatment of late-stage osteonecrosis of the femoral head. Methods: From November 2008 to May 2009, 19 hips in 18 patients with osteonecrosis of the femoral head [6 hips in Association Research Circulation Osseous (ARCO) stage IIC and 13 hips in stage IIIA] were treated with core decompression combined with PRO-DENSE™ (Injectable Regenerative Graft). The average age of the patients at the time of surgery was 48 years (range 25-67 years). Twelve patients (13 hips) overused alcohol, four patients (4 hips) were idiopathic, one patient (1 hip) used corticosteroids, and one patient (1 hip) was post-traumatic. The clinical failure was defined as conversion to total hip arthroplasty or progression in head collapse. Results: At the conclusion of the study, 3 in the 6 stage IIC hips and 8 in the 13 stage IIIA hips were converted to total hip arthroplasty in an average of 8.5 months (range 4-30 months) postoperatively. Advanced collapse of the femoral head awaiting for total hip arthroplasty was observed in the other six hips. Of the 19 hips, only 2 hips (10.5%) survived without further collapse in the 5-year follow-up. This resulted in 89.5% failure rate with early resorption of the grafting in an average of 5.3 months. Conclusions: Core decompression combined with an injectable calcium sulfate and calcium phosphate composite graft (PRO-DENSE) were associated high failure rates in the early postoperative period. It is not recommended for the treatment of ARCO stage IIC and IIIA osteonecrosis of the femoral head.http://www.biomedj.org/article.asp?issn=2319-4170;year=2015;volume=38;issue=3;spage=257;epage=261;aulast=Yubone graft substitutecore decompressionosteonecrosis of the femoral head |
| spellingShingle | Pei-An Yu Kuo-Ti Peng Tsan-Weng Huang Robert Wen-Wei Hsu Wei-Hsiu Hsu Mel S Lee Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up Biomedical Journal bone graft substitute core decompression osteonecrosis of the femoral head |
| title | Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up |
| title_full | Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up |
| title_fullStr | Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up |
| title_full_unstemmed | Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up |
| title_short | Injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head: A 5-year follow-up |
| title_sort | injectable synthetic bone graft substitute combined with core decompression in the treatment of advanced osteonecrosis of the femoral head a 5 year follow up |
| topic | bone graft substitute core decompression osteonecrosis of the femoral head |
| url | http://www.biomedj.org/article.asp?issn=2319-4170;year=2015;volume=38;issue=3;spage=257;epage=261;aulast=Yu |
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