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

• Published in: Journal of hip preservation surgery 2024-11
• Main Authors: Ansari, Sajid, Gupta, Kshitij, Bondarde, Parshwanath, Madhusudan, Ch Raja Bhaskar Venkatasai, Kalia, R.B
• Format: Article
• Language: English
• ISSN: 2054-8397; 2054-8397
• DOI: 10.1093/jhps/hnae027

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, P-value = .012) and visual analog scale scores (7.3 versus 1.2, P-value = .025) were noted postoperatively with no surgical complications. Late presentation (>3 months) (P-value = .001) and presence of BME (P = 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.