Objective To investigate cl inical therapeutic effect on early stage femoral head necrosis managed with allogeneic cortical bone cage support combining with autologous cancellous bone grafting through core decompression tunnel, and to discuss its effect on preventing femoral head collapse and influence factors. Methods From January 2002 to December2005, 40 patients (42 hips) with femoral head necrosis underwent core decompression and an allogeneic threaded cortical bone supporting cage which was loaded with autologous cancellous bone inside. There were 26 males and 14 females, aging 27-45 years (mean 35.6 years). The disease course was 6-28 months (mean 18.3 months). All the cases underwent X-ray, CT and MRI examination to confirm the diagnosis and necrosis area. Twelve hips were at Ficat stage I, 29 hip at stage II, and 1 hips at stage III. Harris hip score system was used to evaluate the hip function pre- and post-operatively. X-ray films were taken regularly after operation. Results All the wound healed by first intention without any compl ications such as infection, fracture, nerve and vascular injury, and deep vein thrombosis. Thirty-six patients (38 hips) were followed up for 24-58 months with an average of 38 months. All the patients had different degrees of improvement in cl inical symptoms. According to Harris hip score system, the Harris score was 63.1 ± 6.4 before operation and 82.3 ± 16.5 at the last follow-up, showing significant difference (P lt; 0.001). The results were excellent in 24 hips, good in 11 hips, fair in 2 hips and poor in 1 hips. The X-ray films showed femoral head repairing and no advancement of osteonecrosis and collapsing in 23 patients (24 hips) 24 months after operation. Conclusion Allogeneic cortical bone cage support combining with autologous cancellous bone grafting is suitable for managing early stagefemoral head necrosis and its short- and middle-term effect is satisfactory.
In order to evaluate the long-term effect of total hip replacement (THR) in patients with steroid-induced femoral head necrosis, 40 cases of 50 hips received THR patients were followed up for an average of 8.5 years after operation. Evaluation was carried act according to Harris score system. In these cases, average score was seventy-five points. Revision rate among them was 2% after four years and 18% after five to eight and a half years, with as overall rate of 20%. It was found that the main reason for revision was looseness of the prosthesis. In this follow-up, it showed that besides foreigen body reaction, abnormal osseous remodelling was the main factor in long-term failure of this arthroplasty. It was also proved that it was a good selection to perform cemented total hip replacement in younger patients, which could improve living quality.
Abstract To understand the femoral head activity in old fracture of femoral neck, 159 cases from 1982 to 1994 were observed through X-ray film, pathological sections, transparent electronic microscope, tetracycline label technique and ECT examination. The results showed that under a status without stress, the avascular femoral head tended to be repaired in its natural way. The collapse of femoral head was caused by stress to some extent duringthe active repair process. Great attention should be paid in treating fracture of femoral neck that load should never be put on the femoral head during the process of fracture healing.
ObjectiveTo study the perioperative treatment of total hip arthroplasty (THA) for avascular necrosis of the femoral head (ANFH) in systemic lupus erythematosus (SLE) patients. MethodsThe clinical data of 27 patients with SLE and ANFH, who underwent 40 THAs between August 2009 and November 2012 were retrospectively analyzed. There were 5 male and 22 female patients, and the average age of the patients at surgery was 40 years ranging from 21 to 66 years. Fourteen cases had unilateral THA and 13 had bilateral THA. The combined disease included 2 cases of hypertension, 3 chronic bronchitis, 1 autoimmune liver disease and hypohepatia, 2 sicca syndrome, and 2 anemia. ResultsAll the patients were stable peri-operatively. No patient had adrenal crisis. Four complications were noted, including one case of fever reaction (maximum temperature:39.3℃), 1 incision fat liquefaction, 1 pulmonary infection, and 1 early dislocation due to improper exercise on the 12th day after the operation. The patients were followed up for 24 to 53 months, and there was no deep infection, prosthetic loosening, peri-prosthetic fracture or deep vein thrombosis after THA. ConclusionAlthough the incidence of postoperative complication is high in patients with SLE and ANFH undergoing THA, meticulous perioperative management can help these patients get through operation safely, including the use of glucocorticoid and antibiotics, treatment of osteoporosis, and prevention and treatment of complications.