Nonvascularized bone grafting defers joint arthroplasty in hip osteonecrosis.
A variety of nonvascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. We retrospectively reviewed 33 patients (39 hips) with osteonecrosis of the hip who had nonvascularized bone grafting procedures with supplemental OP-1. We compared the outcomes in this cohort to similar patients treated nonoperatively or with other nonvascularized bone grafting procedures. We used a trapdoor to make a window at the head-neck junction to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft, marrow, and OP-1. The minimum followup was 24 months (mean, 36 months; range, 24-50 months). We performed no further surgery in 25 of 30 small- and medium-sized lesions (80%) but did in two of nine large lesions. Hips with Ficat Stage II disease were not reoperated in 18 of 22 cases during the followup periods. Our short-term results compare similarly to nonoperative treatment and other reports of nonvascularized bone grafting. With the addition of ancillary growth factors, these procedures effectively reduce donor site morbidity and may defer joint arthroplasty in selected patients.
Seyler
Thorsten M
TM
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Marker
David R
DR
Ulrich
Slif D
SD
Fatscher
Tobias
T
Mont
Michael A
MA
D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D016026:Bone Marrow Transplantation; D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins / Q000494:pharmacology / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005270:Femur Head / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006621:Hip Joint / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration / Q000187:drug effects*; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016212:Transforming Growth Factor beta / Q000494:pharmacology / Q000627:therapeutic use*; D017211:Treatment Failure; D016896:Treatment Outcome
C525819:BMP7 protein, human; D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins; D016212:Transforming Growth Factor beta