[Mid-term efficacy analysis of single-inlet dual-channel core decompression combined with structural bone support in the treatment of early non-traumatic femoral head necrosis].

Abstract

Objective: To explore mid-term clinical efficacy of single-approach dual-channel core decompression combined with structural bone grafting surgery in treating early non-traumatic osteonecrosis of the femoral head(ONFH), as well as influencing factors of postoperative hip joint survival rate.

Methods: A retrospective analysis was conducted on 130 hips of 87 patients with ONFH who underwent single-inlet dual-channel core decompression combined with structural bone support bone grafting from October 2016 to September 2020. Among them, there were 75 males and 12 females;aged from 18 to 59 years old with an average of (37.53±10.31) years old;44 patients were unilateral and 43 patients were bilateral. Harris hip score (HHS), the rate of imaging progression, and failure rate(the surgery was considered a failure if total hip arthroplasty was eventually performed) were observed;the survival curves were plotted using Kaplan-Meier method, Log-rank test was used for comparisons between groups. Cox proportional hazards regression model was employed to analyze independent risk factors, including age, Association Research Circulation Osseous(ARCO) staging, 2021 ARCO classification, China-Japan Friendship Hospital (CJFH) classification, and Japanese Investigation Committee(JIC) classification.

Results: All patients were followed up, the duration ranged from 6 to 76 months, with an average of(53.13±19.06) months. HHS was increased from (78.73±11.52) before operation to (91.70±3.88) at the latest follow-up, and the difference was statistically significant(t=3.305, P=0.008). The imaging results showed at the last follow-up, 21 patients with femoral head collapse had progressed, with progression rate of 16.15%;among 130 hip joints, 31 patients' hip surgery failed and eventually underwent total hip arthroplasty (THA), with a failure rate of 23.85%. The factors contributing to failure of surgery included age (χ²=10.489, P=0.003), ARCO classification (χ²=19.244, P=0.000), JIC classification (χ²=21.734, P=0.000), and CJFH classification (χ²=0.979, P=0.000). Age more than 40 years old (P=0.011), ARCO classification in 2021 (P=0.048), JIC classification (P=0.014), and CJFH classification (P=0.037) were independent risk factors for surgical failure.

Conclusion: Single-inlet dual-channel core decompression combined with structural bone support bone grafting is a highly effective mid-term clinical treatment for hip preservation surgery. To improve the survival rate of the hip joint, it is necessary to strictly adhere to the surgical indications. Patients with ONFH aged 40 years old or above, type 3 according to ARCO in 2021, type C2 according to JIC, and type L3 according to CJFH, are not recommended to undergo this surgical procedure.