Skip to main content

Advertisement

SpringerLink
Log in

Core decompression in combination with nano-hydroxyapatite/polyamide 66 rod for the treatment of osteonecrosis of the femoral head

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to investigate the effectiveness of core decompression in combination with a nano-hydroxyapatite/polyamide 66 (n-HA/PA66) rod and a porous bioglass bone graft for the treatment of osteonecrosis of the femoral head (ONFH).

Methods

Sixty-four patients (84 hips) with ONFH were allocated to a program of either core decompression (CD) in combination with a n-HA/PA66 rod and a porous bioglass bone graft (treatment group) or CD with an autologous cancellous bone graft (control group). Clinical and radiographic retrospective follow-ups were performed on all patients with the prospectively collected data.

Results

The overall clinical failure rate in the treatment group (9/38, 23.68 %) was lower than that of the control group (24/46, 52.17 %) (p < 0.05). Harris hip scores (HHS) were significantly increased in both groups post-surgery (p < 0.05). There was a significant difference between the two groups on HHS improvement for Steinberg IIC and IIIA (p < 0.05 and p < 0.001, respectively). The visual analogue scale (VAS) was significantly decreased in both groups post-surgery (p < 0.05). Especially, significant difference in the VAS improvement was observed between the groups for IIB, IIC and IIIA (p < 0.05, p < 0.05 and p < 0.01, respectively).

Conclusions

Core decompression combined with the implantation of a n-HA/PA66 rod and a bioglass bone graft can significantly decrease hip pain, improve hip function, and prevent the collapse of the femoral head in patients with ONFH. As the effectiveness of this approach appears to vary with Steinberg stage, we suggest that this treatment procedure may be suitable for patients with early to middle stage ONFH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Helbig L et al (2012) Core decompression combined with implantation of a demineralised bone matrix for non-traumatic osteonecrosis of the femoral head. Arch Orthop Trauma Surg 132(8):1095–1103

    Article  CAS  PubMed  Google Scholar 

  2. Floerkemeier T et al (2011) Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis. Int Orthop 35(10):1461–1466

    Article  PubMed Central  PubMed  Google Scholar 

  3. Lieberman JR et al (2012) Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res 470(2):525–534

    Article  PubMed  Google Scholar 

  4. Liu Y, Liu S, Su X (2013) Core decompression and implantation of bone marrow mononuclear cells with porous hydroxylapatite composite filler for the treatment of osteonecrosis of the femoral head. Arch Orthop Trauma Surg 133(1):125–133

    Article  PubMed  Google Scholar 

  5. Rajagopal M, Balch Samora J, Ellis TJ (2012) Efficacy of core decompression as treatment for osteonecrosis of the hip: a systematic review. Hip Int 22(5):489–493

    Article  PubMed  Google Scholar 

  6. Wang CJ et al (2012) Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight- to nine-year follow-up. Biomed J 35(6):481–485

    PubMed  Google Scholar 

  7. Zhao D et al (2013) Tantalum rod implantation and vascularized iliac grafting for osteonecrosis of the femoral head. Orthopedics 36(6):789–795

    Article  PubMed  Google Scholar 

  8. Tetik C et al (2011) Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc 45(5):326–334

    PubMed  Google Scholar 

  9. Mont MA et al (2006) Systematic analysis of classification systems for osteonecrosis of the femoral head. J Bone Joint Surg Am 88(Suppl 3):16–26

    Article  PubMed  Google Scholar 

  10. Hu YC, Zhong JP (2009) Osteostimulation of bioglass. Chin Med J (Engl) 122(19):2386–2389

    Google Scholar 

  11. Lu CL et al (2012) Application of n-HA/PA66 composite artificial vertebral body in anterior reconstruction of lower cervical spine fracture and dislocation. Zhonghua Wai Ke Za Zhi 50(4):338–341

    PubMed  Google Scholar 

  12. Qian X et al (2013) Dynamic perfusion bioreactor system for 3D culture of rat bone marrow mesenchymal stem cells on nanohydroxyapatite/polyamide 66 scaffold in vitro. J Biomed Mater Res B Appl Biomater 101(6):893–901

    Article  PubMed  Google Scholar 

  13. Wang BL et al (2010) Treatment of nontraumatic osteonecrosis of the femoral head using bone impaction grafting through a femoral neck window. Int Orthop 34(5):635–639

    Article  PubMed Central  PubMed  Google Scholar 

  14. Johnson AJ et al (2013) Treatment of femoral head osteonecrosis in the United States: 16-year analysis of the nationwide inpatient sample. Clin Orthop Relat Res. doi:10.1007/s11999-013-3220-3

  15. Eward WC et al (2012) The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible? Clin Orthop Relat Res 470(10):2819–2826

    Article  PubMed  Google Scholar 

  16. Zhao G et al (2013) Radiological outcome analyses of transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head at a mean follow-up of 11 years. J Orthop Sci 18(2):277–283

    Article  PubMed  Google Scholar 

  17. Mont MA et al (1998) Radiographic predictors of outcome of core decompression for hips with osteonecrosis stage III. Clin Orthop Relat Res 354:159–168

    Article  PubMed  Google Scholar 

  18. Fairbank AC et al (1995) Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 77(1):42–49

    CAS  PubMed  Google Scholar 

  19. Powell ET, Lanzer WL, Mankey MG (1997) Core decompression for early osteonecrosis of the hip in high risk patients. Clin Orthop Relat Res 335:181–189

    PubMed  Google Scholar 

  20. Marker DR et al (2008) Do modern techniques improve core decompression outcomes for hip osteonecrosis? Clin Orthop Relat Res 466(5):1093–1103

    Article  PubMed  Google Scholar 

  21. Hernigou P et al (2006) The natural history of asymptomatic osteonecrosis of the femoral head in adults with sickle cell disease. J Bone Joint Surg Am 88(12):2565–2572

    Article  PubMed  Google Scholar 

  22. Ha YC et al (2006) Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am 88(Suppl 3):35–40

    Article  PubMed  Google Scholar 

  23. Petrigliano FA, Lieberman JR (2007) Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res 465:53–62

    PubMed  Google Scholar 

  24. Israelite C et al (2005) Bilateral core decompression for osteonecrosis of the femoral head. Clin Orthop Relat Res 441:285–290

    Article  PubMed  Google Scholar 

  25. Yang X et al (2012) Anterior reconstruction with nano-hydroxyapatite/polyamide-66 cage after thoracic and lumbar corpectomy. Orthopedics 35(1):e66–e73

    PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by the National Science foundation of China (81000809).

Conflict of interest

The authors declare that they have no conflict of interest. All the costs of each patient were covered by the basic medical insurance of China.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Second Affiliated Hospital of Medical College of Xi’an Jiaotong University, No. 157 Xiwu Road, Xi’an, 710004, Shaanxi, People’s Republic of China

    Pei Yang, Chuanbao Bian, Anli Shi, Chunsheng Wang & Kunzheng Wang

  2. Department of Cardiology, First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China

    Xin Huang

Authors
  1. Pei Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chuanbao Bian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anli Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chunsheng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kunzheng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kunzheng Wang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yang, P., Bian, C., Huang, X. et al. Core decompression in combination with nano-hydroxyapatite/polyamide 66 rod for the treatment of osteonecrosis of the femoral head. Arch Orthop Trauma Surg 134, 103–112 (2014). https://doi.org/10.1007/s00402-013-1885-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1885-4

Keywords

Search

Navigation