title: [Long-term follow-up of early-middle stage avascular necrosis of femoral head with core decompression and bone grafting].
abstract: OBJECTIVE
  To evaluate the long-term effectiveness of treating early-middle stage avascular necrosis of the femoral head (ANFH) with core decompression and bone grafting.
  
  
  METHODS
  Between January 2000 and December 2006, 87 ANFH patients (114 hips) were treated with core decompression and bone grafting, including 54 cases (62.1%) of alcohol-induced ANFH, 26 cases (29.9%) of steroid-induced ANFH, and 7 cases (8.0%) of idiopathic ANFH. There were 74 males (97 hips) and 13 females (17 hips), aged 20-56 years (mean, 38 years). The disease duration was 3-46 months (mean, 18 months). According to Ficat staging, 16 hips were at stage I, 68 hips at stage II, and 30 hips at stage III. The Harris score and Ficat stage were compared between pre- and post-operation to assess the outcomes clinically and radiologically. The hip survival was analyzed by the Kaplan-Meier method.
  
  
  RESULTS
  Eighty-seven patients were followed up 5 years to 11 years and 10 months (mean, 8 years and 9 months). The Harris hip score was significantly increased from 73.13 +/- 7.17 at preoperation to 81.59 +/- 13.23 at postoperation (t = -9.318, P = 0.000). The clinical success rate was 69.3% (79/114) and the radiological success rate was 54.4% (62/114). Kaplan-Meier survival analysis showed that the overall survival rate was 84.2% (96/114); the survival rates of Ficat stage I [100% (16/16)] and stage II [91.2% (62/68)] were higher than that of stage III [60.0%(18/30)] (P < 0.01); there was no significant difference between Ficat stage I and II (chi2 = 1.520, P = 0.218).
  
  
  CONCLUSIONS
  Core decompression with bone grafting is a safe and effective procedure for the treatment of Ficat stages I-II (early stage) ANFH, and the long-term effectiveness is satisfactory. But the long-term effectiveness is unsatisfactory for the patients at the Ficat stage III (middle stage).
authors.affiliation: Department of Orthopedics, National Hospital of Guangxi Zhuang Autonomous Region, Nanning Guangxi 530001, PR China.
authors.forename: Dehuai
authors.initials: D
authors.lastname: Liu
authors.forename: Qianfen
authors.initials: Q
authors.lastname: Chen
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chen
authors.forename: Yun
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult