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Arthroscopy Assisted Lesion Clearance and Bone Graft, Titanium Rod Support Treatment of Early Stage Osteonecrosis of the Femoral Head of the Postoperative Survival Rate Analysis

DOI: 10.4236/ss.2017.81005, PP. 37-46

Keywords: Femur Head Necrosis, Survival Rate, Treatment Outcome

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Abstract:

Objective: To assess the curative effect of the stage II femoral head necrosis treated by arthroscopy assisted lesion clearance, bone graft and titanium rod support. Methods: All the patients (including 58 patients 74 hips) were diagnosed as stage II femoral head necrosis according to the ARCO staging system during 2003-2013. In these patients, 15 hips were stage IIA, 34 hips were stage IIB and 25 hips were stage IIC. Located by C-arm and assisted by arthroscopy, minimally-invasive percutaneous pulp core decompression and lesion clearance within the femoral head were accurately performed, and then, the OAM composite of autologous bone marrow was implanted and the femoral head was supported using the titanium rod. Follow-up including the pain score, the Harris hip score and X-ray observation for disease progression were achieved at 6, 12, 24 and 36 months postoperatively, Kaplan-Meier survival curve was used for the survival analysis. Result: The VAS score and the Harris score after operation were better THRAn THRAt of before the surgery, the difference had statistical significance (p < 0.05). As for the X-ray staging, 5 cases (5 hips) progressed from stage IIB to stage IIC, the femoral head of 6 cases (6 hips) staged IIC collapsed at 24 months after the operation and then underwent THRA after 30 months. In this study, the total improvement rate after the surgery was 79.72% (93.33% for IIA, 82.35% for IIB and 68% for IIC). The total survival rate of these patients was 64.2% (95% CI, 64.2% - 90.1%). Conclusion: Arthroscopy assisted lesion clearance, bone graft and titanium rod support to treat the stage II osteonecrosis of the femoral head are effective and can prevent the femoral head from collapsing. But for stage IIC patients who had a history of the use of hormone, this surgery should be chosen carefully because the outcome is always very poor.

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