Outcomes of single-incision-augmented core decompression using trochanteric autograft in osteonecrosis of femoral head-a mean 5-year follow-up study.

Abstract

Osteonecrosis of femoral head (ONFH) can be a debilitating disease, for which numerous salvage surgeries have been popularized to halt its progression. The aim of this study was to assess the clinical and radiological outcomes of a single-incision core decompression (CD) technique using trochanteric autograft in ONFH and to determine the prognostic factors of treatment success. Sixty-six hips (41 patients) of Association Research Circulation (ARCO) 1 and 2 ONFH undergoing CD were included in the study with a mean follow-up of 58 months. Treatment failure was taken as radiographic collapse and/or conversion to total hip arthroplasty (THA). The following clinical and radiological factors impacting outcomes were evaluated-symptom duration, etiology, age, sex and body mass index, ARCO grade, Japanese Investigation Committee grade, modified Kerboul angle, and bone marrow edema (BME) on magnetic resonance imaging. Twenty-one of the 66 hips (31.8%) had a radiological collapse by the last follow-up, and 6 hips (9%) required THA. Overall, significant improvement in Harris hip scores (60.18 versus 80.81, <i>P</i>-value = .012) and visual analog scale scores (7.3 versus 1.2, <i>P</i>-value = .025) were noted postoperatively with no surgical complications. Late presentation (>3 months) (<i>P</i>-value = .001) and presence of BME (<i>P</i> = 0.0002) were significantly correlated with poor outcomes. The 5-year collapse-free rate was 68.2%, and 91% hips were arthroplasty free. Our single-incision CD technique using a trochanteric autograft yielded favorable outcomes for precollapse stages of nontraumatic ONFH at 5-year follow-up. Delayed presentation and presence of BME are poor prognostic factors. Adequate patient selection is for achieving a good survivorship and improvement in patient-reported outcomes.