Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIA Tianwei , WEI Wei , ZHANG Chao , JI Wenhui ,  SHEN Jirong

Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China;

Corresponding author：

SHEN Jirong, Email: joint66118@sina.com

Keywords：

Avascular necrosis of the femoral head; China-Japan Friendship Hospital Classification; staging treatment; hip preservation; experience

DOI：

10.7507/1002-1892.201904075

Video：

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Objective To sum up staging treatment experiences of hip preservation for avascular necrosis of the femoral head (ANFH) according to China-Japan Friendship Hospital Classification (CJFH Classification).Methods The literature about hip preservation of ANFH was extensively reviewed, and a staging treatment method for ANFH was set up base on CJFH Classification and the 28 years of clinical experience in this research group.Results According to CJFH Classification, the ANFH can be rated as types M, C, and L. And the type L is rated as L1, L2, and L3 subtypes. The staging treatment method for ANFH based on CJFH Classification is set up. Conservative treatment was selected for CJFH-M patients because the necrotic area is small and in the medial non-weight-bearing area. Minimally invasive sequestrum clearance, impacting bone graft, and supporting allogenic fibular graft is selected for CJFH-C patients because the necrotic area is also small and in the lateral non-weight-bearing area. If patients are in CJFH-L1, normal bone area is less than 1/3 on hip abduction radiograph, the sequestrum clearance and impacting bone graft via surgical hip dislocation approach can be selected. If patients are in CJFH-L1, normal bone area is more than 1/3 on hip abduction radiograph, the transtrochanteric curved varus osteotomy can be selected. The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is for CJFH-L2 patients. Total hip arthroplasty via direct anterior approach is for CJFH-L3 patients.Conclusion The staging treatment method for ANFH according to CJFH Classification has good short-term effectiveness. But the long-term effectiveness needs further follow-up.

Citation： XIA Tianwei, WEI Wei, ZHANG Chao, JI Wenhui, SHEN Jirong. Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 10-15. doi: 10.7507/1002-1892.201904075 Copy

1.	Kaushik AP, Das A, Cui Q. Osteonecrosis of the femoral head: An update in year 2012. World J Orthop, 2012, 3(5): 49-57.
2.	Marker DR, Seyler TM, McGrath MS, et al. Treatment of early stage osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90(Suppl 4): 175-187.
3.	杜斌, 孙鲁宁, 沈计荣, 等. 微创死骨清除打压植骨腓骨支撑配合中药补肾活血汤治疗早中期股骨头坏死的临床报道. 中华关节外科杂志 (电子版), 2013, 7(3): 404-407.
4.	Fairbank AC, Bhatia D, Jinnah RH, et al. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg (Br), 1995, 77(1): 42-49.
5.	Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg, 2010, 130(7): 859-865.
6.	Aoyama T, Fujita Y, Madoba K, et al. Rehabilitation program after mesenchymal stromal cell transplantation augmented by vascularized bone grafts for idiopathic osteonecrosis of the femoral head: a preliminary study. Arch Phys Med Rehabil, 2015, 96(3): 532-539.
7.	Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
8.	Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
9.	Zhao G, Yamamoto T, Motomura G, et al. 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, 2013, 18(2): 277-283.
10.	Scheider W, Algner N, Pinggera O, et al. Intertrochanteric osteotomy for avascular necrosis of the femoral head of the femur. Survival probability of two different methods. J Bone Joint Surg (Br), 2002, 84(6): 817-824.
11.	Lieberman JR, Engstrom SM, Meneghini RM, et al. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res, 2012, 470(2): 525-534.
12.	Ficat RP, Arlet J. Necrosis of the femoral head//Hungerford DS, ed. Ischemia and necrosis of bone. Baltimore: Williams & Wilkins, 1980: 171-182.
13.	Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br), 1995, 77(1): 34-41.
14.	Gardeniers JW. A new international classification of osteonecrosis of the ARCO Committee on terminology and classification. J Jpn Orthop Assoc, 1992, 66(2): S18-S19.
15.	Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
16.	李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型—中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
17.	Pauwels F. The place of osteotomy in the operative management of osteoarthritis of the hip. Triangle, 1968, 8(6): 196-210.
18.	Hasegawa Y, Yamaguchi J, Kanoh T, et al. Low signal intensity area by magnetic resonance imaging that disappeared after a curved intertrochanteric varus osteotomy for traumatic osteonecrosis of the femoral head. J Orthop Sci, 2008, 13(3): 265-268.
19.	施乐, 樊燕鑫, 张超, 等. 虚拟现实技术术前规划在经转子间弧形内翻截骨术治疗成人股骨头缺血性坏死中的应用价值. 中国修复重建外科杂志, 2019, 33(8): 923-928.
20.	Yao C, Yi N, Shen J, et al. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade ⅢA-ⅢB aseptic necrosis of femoral head (ANFH) patients. Oncotarget, 2017, 8(30): 50084-50090.
21.	夏天卫, 魏伟, 刘金柱, 等. 经外科脱位入路打压植骨术与旋转截骨术治疗 ARCO Ⅲ期股骨头缺血性坏死疗效比较. 中国修复重建外科杂志, 2019, 33(4): 445-450.
22.	Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res, 1978, (130): 191-201.
23.	Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis. Follow-up statistics. Clin Orthop Relat Res, 1982, (169): 115-126.
24.	Dean MT, Cabanela ME. Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. J Bone Joint Surg (Br), 1993, 75(4): 597-601.
25.	Chughtai M, Piuzzi NS, Khlopas A, et al. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J, 2017, 99-B(10): 1267-1279.

1. Kaushik AP, Das A, Cui Q. Osteonecrosis of the femoral head: An update in year 2012. World J Orthop, 2012, 3(5): 49-57.
2. Marker DR, Seyler TM, McGrath MS, et al. Treatment of early stage osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90(Suppl 4): 175-187.
3. 杜斌, 孙鲁宁, 沈计荣, 等. 微创死骨清除打压植骨腓骨支撑配合中药补肾活血汤治疗早中期股骨头坏死的临床报道. 中华关节外科杂志 (电子版), 2013, 7(3): 404-407.
4. Fairbank AC, Bhatia D, Jinnah RH, et al. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg (Br), 1995, 77(1): 42-49.
5. Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg, 2010, 130(7): 859-865.
6. Aoyama T, Fujita Y, Madoba K, et al. Rehabilitation program after mesenchymal stromal cell transplantation augmented by vascularized bone grafts for idiopathic osteonecrosis of the femoral head: a preliminary study. Arch Phys Med Rehabil, 2015, 96(3): 532-539.
7. Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
8. Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
9. Zhao G, Yamamoto T, Motomura G, et al. 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, 2013, 18(2): 277-283.
10. Scheider W, Algner N, Pinggera O, et al. Intertrochanteric osteotomy for avascular necrosis of the femoral head of the femur. Survival probability of two different methods. J Bone Joint Surg (Br), 2002, 84(6): 817-824.
11. Lieberman JR, Engstrom SM, Meneghini RM, et al. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res, 2012, 470(2): 525-534.
12. Ficat RP, Arlet J. Necrosis of the femoral head//Hungerford DS, ed. Ischemia and necrosis of bone. Baltimore: Williams & Wilkins, 1980: 171-182.
13. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br), 1995, 77(1): 34-41.
14. Gardeniers JW. A new international classification of osteonecrosis of the ARCO Committee on terminology and classification. J Jpn Orthop Assoc, 1992, 66(2): S18-S19.
15. Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
16. 李子荣, 刘朝晖, 孙伟, 等. 基于三柱结构的股骨头坏死分型—中日友好医院分型. 中华骨科杂志, 2012, 32(6): 515-520.
17. Pauwels F. The place of osteotomy in the operative management of osteoarthritis of the hip. Triangle, 1968, 8(6): 196-210.
18. Hasegawa Y, Yamaguchi J, Kanoh T, et al. Low signal intensity area by magnetic resonance imaging that disappeared after a curved intertrochanteric varus osteotomy for traumatic osteonecrosis of the femoral head. J Orthop Sci, 2008, 13(3): 265-268.
19. 施乐, 樊燕鑫, 张超, 等. 虚拟现实技术术前规划在经转子间弧形内翻截骨术治疗成人股骨头缺血性坏死中的应用价值. 中国修复重建外科杂志, 2019, 33(8): 923-928.
20. Yao C, Yi N, Shen J, et al. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade ⅢA-ⅢB aseptic necrosis of femoral head (ANFH) patients. Oncotarget, 2017, 8(30): 50084-50090.
21. 夏天卫, 魏伟, 刘金柱, 等. 经外科脱位入路打压植骨术与旋转截骨术治疗 ARCO Ⅲ期股骨头缺血性坏死疗效比较. 中国修复重建外科杂志, 2019, 33(4): 445-450.
22. Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res, 1978, (130): 191-201.
23. Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis. Follow-up statistics. Clin Orthop Relat Res, 1982, (169): 115-126.
24. Dean MT, Cabanela ME. Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. J Bone Joint Surg (Br), 1993, 75(4): 597-601.
25. Chughtai M, Piuzzi NS, Khlopas A, et al. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J, 2017, 99-B(10): 1267-1279.

Chinese Journal of Reparative and Reconstructive Surgery

Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification

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