title: Inverted femoral head graft versus standard core decompression in nontraumatic hip osteonecrosis at minimum 3 years follow-up.
abstract: OBJECTIVE
  Numerous salvage surgeries were popularised to halt the progression of hip osteonecrosis (ON). We aimed to compare the clinico-radiological outcomes of inverted femoral head graft (IFHG) versus standard core decompression (SCD) in treatment of nontraumatic hip ON at pre-arthritic stage.
  
  
  METHODS
  A case review was performed at a minimum 3 years follow-up of 61 patients (71 hips; mean age 32.96 (19-50) years; mean follow-up 7.86 (3-14) years; mean body mass index 28.58 (19-46); 32 males, 29 females) suffering nontraumatic hip ON at pre-arthritic stage. 38 hips underwent SCD and 33 IFHG. The outcome was assessed by changes in modified Harris Hip Score (MHHS), need for revision surgery and progression of modified Ficat-Arlet staging. Data were analysed including logistic regression and Kaplan-Meier survivorship analysis.
  
  
  RESULTS
  13/34 (38.2%) hips in SCD group were revised at 4.61 ± 2.61 years, while 7/33 (21.2%) in IFHG group at 8.43 ± 4.32 years (p = 0.023). MHHS was significantly higher in IFHG group at 1 and 3 years as well as at last follow-up (p = 0.014, 0.001 and 0.023 respectively). Clinical and radiological significant differences were found in survivorship analysis between both groups, in favor of IFHG. A higher clinical failure was noted among obese patients.
  
  
  CONCLUSIONS
  An IFHG technique offers a better alternative regarding postoperative clinico-radiological outcomes in nontraumatic hip ON at the pre-arthritic stage. A cautious prognosis is recommended in obese patients.
authors.affiliation: Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia - Egypt.
authors.forename: Asser A
authors.initials: AA
authors.lastname: Sallam
authors.affiliation: Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia - Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Imam
authors.affiliation: Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Ismailia - Egypt.
authors.forename: Khaled S
authors.initials: KS
authors.lastname: Salama
authors.affiliation: Department of Orthopaedic Surgery, Al-Azhar University Hospital, Damietta - Egypt.
authors.forename: Osman A
authors.initials: OA
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D000367:Age Factors; D016025:Bone Transplantation / Q000379:methods*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006085:Graft Survival; D006621:Hip Joint / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult