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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2015

Open Access 01-12-2015 | Research article

Treatment of osteonecrosis of the femoral head with focal anatomic-resurfacing implantation (HemiCAP): preliminary results of an alternative option

Authors: Onur Bilge, Mahmut Nedim Doral, Mustafa Yel, Nazim Karalezli, Anthony Miniaci

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2015

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Abstract

Background

The optimal treatment of osteonecrosis of the femoral head has not been established yet. The aim of this study was to report preliminary clinical results of focal anatomic-resurfacing implantation for the treatment of osteonecrosis of the femoral head.

Methods

Five patients (four male, one female) with seven surgical procedures, ages between 37 and 52 with an average age of 45.2 (+/− 7.2), diagnosed as femoral head avascular necrosis and who were unresponsive to conservative management or had failed previous surgical treatments were treated with a focal anatomic femoral head resurfacing between the years 2011–2012 and were retrospectively reviewed. Five patients with at least two years of follow-up, one left hip, two right hips, and two patients with bilateral hip surgery were included in this review. After safe surgical dislocation of the hip, full exposure of the femoral head was established. A focal-resurfacing implant matching patient anatomy and femoral head curvature was performed accordingly. Neither intraoperative or postoperative complications nor revision ensued. Visual analogue scores and Harris Hip Scores were recorded both preoperatively and at postoperative 2 years for all seven surgeries.

Results

The mean follow-up period was 26.6 +/− 3.8 months, with a range between 24–33 months. The mean visual analogue scores were 8.9 +/− 0.9 preoperatively and 2.3 +/− 1.0 postoperatively at year two (p = 0.017). Harris Hip Scores at postoperative follow-up were found to improve significantly from good to excellent scores (86.0 +/− 7.9), compared with preoperative poor scores (26.7 +/− 11.8) (p = 0.018). The clinical improvements in visual analogue scores (VAS) and Harris Hip Scores were also found to correlate with each other (p < 0.05).

Conclusions

In the present study, the alternative technique of focal anatomic hip resurfacing with HemiCAP® yielded preliminary successful results for the treatment of osteonecrosis of the femoral head. To the best of our knowledge, this is the first case series in the literature, reporting functional clinical results with the use of a focal anatomic-resurfacing implant for the treatment of focal femoral head osteonecrosis.
Literature
1.
Mont MA, Hungerfort DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459–74.PubMed
2.
Jones LC, Hungerford DS. Osteonecrosis: etiology, diagnosis, and treatment. Curr Opin Rheumatol. 2004;16:443–9.CrossRefPubMed
3.
Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg. 2014;22:455–64.CrossRefPubMed
4.
Pivec IK, Kapadia BH, Banerjee S, Mont MA. Osteonecrosis of the femoral head. Bone Joint J. 2013;95-B(Suppl A):46–50002E.
5.
Lee JS, Lee JS, Rob HL, Kim CH, Js J, Suh KT. Alteration in the differentiation ability of mesenchymal stem cells in patients with nontraumatic osteonecrosis of the femoral head: comparative analysis according to the risk factor. J Orthop Res. 2006;24(4):604–9.CrossRefPubMed
6.
Liebermann JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect. 2003;52:337–55.
7.
Zibis AH, Karantanas AH, Roidis NT, Hantes ME, Argiri P, Moraitis T, et al. The role of MR imaging in staging femoral head osteonecrosis. Eur J Radiol. 2007;63(1):3–9.CrossRefPubMed
8.
Ficat RP, Arlet J. Forage-biopsie de la tete femorale dans l’osteonecrose primitive. Observations histo-pathologiques portant sur huit forages. Rev Rheum. 1964;31:257–64.
9.
Ficat RP. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J Bone Joint Surg (Br). 1985;67:3–9.
10.
11.
Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br). 1995;77(1):34–41.
12.
Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am. 2006;88 Suppl 3:35–40.CrossRefPubMed
13.
Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996;324:169–78.CrossRefPubMed
14.
Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis: a randomized clinical study. J Bone Joint Surg Am. 2005;87(10):2155–9.CrossRefPubMed
15.
Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ. Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: a two-year multicenter, prospective, randomized, double-blind, placebo study. Arthritis Rheum. 2012;64(5):1572–8.CrossRefPubMed
16.
Glueck CJ, Freiberg RA, Sieve L, Wang P. Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. Clin Orthop Relat Res. 2005;435:164–70.CrossRefPubMed
17.
Ajmal M, Matas AJ, Kuskowski M, Cheng EY. Does statin use reduce the risk of corticosteroid-related osteonecrosis in renal transplant population? Orthop Clin North Am. 2009;40:235–9.CrossRefPubMedCentralPubMed
18.
Disch AC, Matziolis G, Perka C. The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intervenous iloprost. J Bone Joint Surg (Br). 2005;87:560–4.CrossRef
19.
Wang CJ, Wang FS, Huang CC, Yang KD, Weng LH, Huang HY. Treatment for osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core decompression and bone grafting. J Bone Joint Surg Am. 2005;87(11):2380–7.CrossRefPubMed
20.
Masssari L, Fini M, Cadossi R, Setti S, Traina GC. Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88-A(Suppl):56–60.CrossRef
21.
Camporesi EM, Vezzani G, Bosco G, Mangar D, Bernasel TL. Hyperbaric oxygen therapy in femoral head avascular necrosis. J Arthroplasty. 2010;25(Suppl):118–23.CrossRefPubMed
22.
Buckley PD, Gearen PF, Petty RW. Structural bone-grafting for early atraumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1991;73:1357–64.PubMed
23.
Gangji V, De Maertelaer V, Hauzer JP. Autologous bone marrow cell implantation in the treatment of non-traumatic osteonecrosis of the femoral head: five year follow-up of a prospective controlled study. Bone. 2011;49:1005–9.CrossRefPubMed
24.
Zhao D, Cui D, Wang B, Tian F, Guo L, Yang L, et al. Tretment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured stem cells. Bone. 2012;50:325–30.CrossRefPubMed
25.
Ibrahim V, Dowling H. Platelet-rich plasma as a nonsurgical treatment option for osteonecrosis. PM R. 2012;4:1015–9.CrossRefPubMed
26.
Lieberman JR, Conduah A, Urist MR. Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop Relat Res. 2004;429:139–45.CrossRefPubMed
27.
Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am. 1995;77:681–94.PubMed
28.
Veilette CJ, Mehdian H, Schemitsch EH, McKee MD. Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88 suppl 3:48–55.CrossRef
29.
Mont MA, Fairbank AC, Krackow KA, Hungerford DS. Corrective osteotomy for osteonecrosis of the femoral head. J Bone Joint Surg Am. 1996;78(7):1032–8.PubMed
30.
Muraki M, Sudo A, Hasegawa M, Fukuda A, Uchida A. Long-term results of bipolar hemiarthroplasty for osteoarthritis of the hip and idiopathic osteonecrosis of the femoral head. J Orthop Sci. 2008;13:313–7.CrossRefPubMed
31.
Kabata T, Maeda T, Tanaka K, Yoshida H, Kajino Y, Horii T, et al. Hemi-resurfacing versus total resurfacing for osteonecrosis of the femoral head. J Orthop Surg. 2011;19:177–80.
32.
Kim YH, Js K, Park JW, Joo JH. Contemporary total hip arthroplasty with or without cement in patients with osteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report. J Bone Joint Surg Am. 2011;93:1806–10.PubMed
33.
Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berleman U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg (Br). 2001;83-B:1119–24.CrossRef
34.
Lavernia CJ, Sierra RJ. Core decompression in atraumatic osteonecrosis of the hip. J Arthroplasty. 2000;15:171–8.CrossRefPubMed
35.
Banerjee S, Issa K, Pivec R, Kapadia BH, Khanuia HS, Mont MA. Osteonecrosis of the hip: treatment options and outcomes. Orthon Clin N Am. 2013;44:463–76.CrossRef
36.
Amanatullah DF, Strauss EJ, Di Cesare PE. Current management of options for osteonecrosis of the femoral head: part II. Operative management Am J Orthop. 2011;40(10):216–25.
37.
Lee MS, Hsieh PH, Chang YH, Chan YS, Agrawal S, Ueng SW. Elevated intraosseous pressure in the intertrochanteric pressure in the intertrochanteric region is associated with poorer results in osteonecrosis of the femoral head treated by multiple drilling. J Bone Joint Surg (Br). 2008;90:852–7.CrossRef
38.
Berend KR, Gunneson EE, Urbaniak JR. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg Am. 2003;85-A(6):987–93.PubMed
39.
Eward WC, Rineer CA, Urbaniak JR, Richard MJ, Ruch DS. The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible? Clin Orthop Relat Res. 2012;470(10):2819–26.CrossRefPubMedCentralPubMed
40.
Ortiguera CJ, Pulliam IT, Cabanela ME. Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term follow-up. J Arthroplasty. 1999;14(1):21–8.CrossRefPubMed
41.
Kim YH, Oh SH, Kim JS, Koo KH. Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head. J Bone Joint Surg Am. 2003;85(4):675–81.PubMed
42.
Radl R, Hungerford M, Materna W, Rehak P, Windhager R. Higher failure rate and stem migration of an uncemented femoral component in patients with femoral head osteonecrosis than in patients with osteoarthritis. Acta Orthop. 2005;76(1):49–55.CrossRefPubMed
43.
Brinker MR, Rosenberg AG, Kull L, Galante JO. Primary total hip arthroplasty using noncemented porous-coated femoral components in patients with osteonecrosis of the femoral head. J Arthoplasty. 1994;9:457–68.CrossRef
44.
Hartley WT, McAuley JP, Culpepper WJ, Engh Jr CA, Engh Sr CA. Cementless total hip arthroplasty for hip osteonecrosis. J Bone Joint Surg Am. 2000;84:1100.
45.
Beaulé PE, Dorey FJ. Survivorship analysis of cementless total hip arthroplasty in younger patients. J Bone Joint Surg Am. 2001;83:1590–1.PubMed
46.
Taylor AH, Shannon M, Whitehouse SL, Lee MB, Learmonth ID. Harris Galante cementless acetabular replacement in avascular necrosis. J Bone Joint Surg (Br). 2001;83:177–82.CrossRef
47.
Leuning M, Ganz R. The evolution and concepts of joint-preserving surgery of the hip. Bone Joint J. 2014;96-B:5–18.CrossRef
48.
Mont MA, Rajadhyaksha AD, Hungerford DS. Outcomes of limited femoral resurfacing arthroplasty compared with total hip arthroplasty for osteonecrosis of the femoral head. J Arthroplasty. 2001;16(8 Suppl 1):134–9.CrossRefPubMed
49.
Beaulé PE, Amstutz HC, Le Duff M, Dorey F. Surface arthroplasty for osteonecrosis of the hip: hemi-resurfacing versus metal-on-metal hybrid resurfacing. J Arthroplasty. 2004;27:54–8.
50.
Squire M, Fehring TK, Odum S, Griffin WL, Bohannon MJ. Failure of femoral surface replacement for femoral head avascular necrosis. J Arthroplasty. 2005;20:108–14.CrossRefPubMed
51.
Marker DR, Seyler TM, Jinnah RH, Delanois RE, Ulrich SD, Mont MA. Femoral neck fractures after metal-on-metal total hip resurfacing: a prospective cohort study. J Arthroplasty. 2007;22(7, suppl 3):66–71.
52.
Jäger M, Begg MJW, Krauspe R. Partial hemi-resurfacing of the hip joint - a new approach to treat local osteochondral defects? Biomed Tech. 2006;51:371–6.CrossRef
53.
Van Stralen RA, Haverkamp D, Van Bergen CJA, Eijer H. Partial resurfacing with varus osteotomy for an osteochondral defect of the femoral head. Hip Int. 2009;19(1):67–70.PubMed
54.
Mahmud T, Naudie DDR. Partial hip resurfacing for an osteochondral defect of the femoral head. J Bone Joint Surg Case Connect. 2012;2, e14.CrossRef
55.
Lea MA, Barkatali B, Porter ML, Board TN. Osteochondral lesion of the hip treated with partial femoral head resurfacing. Case report and six-year follow-up. Hip Int. 2014 Apr 17:0. doi: 10.5301/hipint.5000121. [Epub ahead of print].
Metadata
Title
Treatment of osteonecrosis of the femoral head with focal anatomic-resurfacing implantation (HemiCAP): preliminary results of an alternative option
Authors
Onur Bilge
Mahmut Nedim Doral
Mustafa Yel
Nazim Karalezli
Anthony Miniaci
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2015
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-015-0199-3

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