Clinical Effects Of Core Decompression Combined With Tantalum Rod Implantation In The Treatment Of Early Stage ONFH

Backgrounds and ObjectiveOsteonecrosis of femoral head(ONFH),previously named avascular necrosis,has been proved to be a debilitating disease,of which more than 80%progress to femoral head collapse.So it's early treatment is particularly important.Porous tantalum rod implantation is considered to be one of the feasible methods for treatment of early stage ONFH.To evaluate the clinical effect of core decompression combined with tantalum rod implantation in the treatment of early stage ONFH.To explore the factors that influence the curative effect through the analysis of failure cases.Help to make the right choice of tantalum rod implantation.Methods16 cases of early-stage osteonecrosis of the femoral head were followed up successfully,including 14 males(15 hips)and 2 females(2 hips).The statistical information including preoperative basic information(gender,age,body weight,height,symptoms,signs,imaging data such as MRI and X-ray),the relevant information from operation records,the postoperative recovery,the preoperative Harris score and the postoperative Harris score.For those who had underwent the THA,chose the Harris score before the THA as the last follow-up score to participate in statistical analysis.Results1.The mean duration of follow-up time was 36.88±28.81 months(2?90 months).The mean preoperative Harris score was 65.06±21.80(22?96).Primary healing of incision was achieved in all patients and no complication occurred.2.During the follow-up period,4 patients suffered progressive collapse of the femoral head,of which 3 cases had undergone total hip arthroplasty,and the other one was treated with conservative treatment.The average Harris score at the last follow-up was 82.94±19.66(36?100).A score of 90?100 was excellent,80?89 was good,70?79 was fair,and<70 was poor.The outcomes show 11 excellent,2 good,0 fair and 4 poor.Harris scores>70 were defined as clinical success.The success rate of postoperative Harris score is 76.47%.There exists significant statistically difference between preoperative and postoperative Harris score(P<0.05).3.To detect the relation between clinical effect and the following factors including etiology,age,preoperative Harris score,follow-up time(months),preoperative Steinberg stage,the length of tantalum rod,operative time,intraoperative blood loss(ml),body mass index(BMI),the onset time(months)and postoperative hospitalized days.The result illustrates that the clinical effects of alcoholic type are better than hormone type and idiopathic type.A few factors have negatively correlation with the postoperative clinical effect,including preoperative score and preoperative Steinberg stage.While the onset time(months)has a positive correlation with the clinical effect.ConclusionsWe find this group of patients have a higher success rate than those from the pertinent literatures of others.We think this situation may be elicited by stricter indications we chose.All these patients are in Steinberg stage ? or ?.We chose muscle bone flap implantation surgery for the patients in Steinberg stage III.These results manifest that core decompression combined with porous tantalum rod implantation is an effective treatment for early stage of ONFH(Steinberg stage I and II).It has significant effects in the alleviation of the pain and the recovery of articular function.Especially for the patients whose ONFH was induced by ethanol.To sum up,core decompression combined with tantalum rod implantation is an effective method for the treatment of early stage of ONFH,especially for those alcohol-induced ONFH patients.The exactly indications are the patients of Steinberg stage I and II.