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Real-time computerised tomography assisted porous tantalum implant in ARCO stage I-II non-traumatic osteonecrosis of the femoral head: minimum five-year follow up

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Abstract

Purposes

This study was established to investigate the medium-term clinical effect of real-time CT assisted porous tantalum implant for the treatment of ARCO stage I-II non-traumatic osteonecrosis of the femoral head (ONFH).

Methods

This study comprised 24 ONFH patients (29 hips) who were treated with intra-operative real-time CT accurate rapid positioning assisted drilling decompression, lesion removal and porous tantalum implant. Harris score, VAS score and imaging in pre-operation and follow-up period were recorded.

Results

The average operative time and intra-operative blood loss were 72.6 min and 158.8 ml, respectively. The mean follow-up was 5.4 years. No femoral head penetrating, wound infection, and death occurred. Harris and VAS score improved significantly (73.78 vs. 88.11; 7.13 vs. 2.66) at last follow-up (P < 0.05). The functional improvement and pain relief rate was 100% at six months after operation. The effective rate was 86.21% at 12 months after operation and last follow-up. Five pre-operative ARCO stage I hips had no radiographic progress. Meanwhile, four among the 24 ARCO stage II hips progressed into stage III between eight and 12 months after surgery, among which two progressed into stage IV and two remained in stage III at the last follow-up. The average value of Kerboul combined necrotic angle was 263.24°. There was no progress in Kerboul combined necrotic angle among the grades 2 and 3 patients. However, among the six cases at grade 4, four cases with post-operative progress, two patients converted to THA.

Conclusions

Our technique is safety and effective in the treatment of ARCO stage I-II non-traumatic ONFH.

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References

  1. Feng Y, Yang SH, Xiao BJ, Xu WH, Ye SN, Xia T, Zheng D, Liu XZ, Liao YF (2010) Decreased in the number and function of circulation endothelial progenitor cells in patients with avascular necrosis of the femoral head. Bone 46(1):32–40. https://doi.org/10.1016/j.bone.2009.09.001

    Article  PubMed  CAS  Google Scholar 

  2. Kamiya N, Yamaguchi R, Aruwajoye O, Adapala NS, Kim HK (2015) Development of a mouse model of ischemic osteonecrosis. Clin Orthop Relat Res 473(4):1486–1498. https://doi.org/10.1007/s11999-015-4172-6

    Article  PubMed  PubMed Central  Google Scholar 

  3. Issa K, Pivec R, Kapadia BH, Banerjee S, Mont MA (2013) Osteonecrosis of the femoral head: the total hip replacement solution. Bone Joint J 95-B(11 Suppl A):46–50. https://doi.org/10.1302/0301-620X.95B11.32644

    Article  PubMed  CAS  Google Scholar 

  4. Hang D, Wang Q, Guo C, Chen Z, Yan Z (2012) Treatment of osteonecrosis of the femoral head with VEGF165 transgenic bone marrow mesenchymal stem cells in mongrel dogs. Cells Tissues Organs 195(6):495–506. https://doi.org/10.1159/000329502

    Article  PubMed  CAS  Google Scholar 

  5. Mankin HJ (1992) Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 326(22):1473–1479. https://doi.org/10.1056/NEJM199205283262206

    Article  PubMed  CAS  Google Scholar 

  6. Ajmal M, Matas AJ, Kuskowski M, Cheng EY (2009) Does statin usage reduce the risk of corticosteroid-related osteonecrosis in renal transplant population? Orthop Clin N Am 40(2):235–239. https://doi.org/10.1016/j.ocl.2009.01.004

    Article  Google Scholar 

  7. Castro FP Jr, Barrack RL (2000) Core decompression and conservative treatment for avascular necrosis of the femoral head: a meta-analysis. Am J Orthop 29(3):187–194

    PubMed  Google Scholar 

  8. Bobyn JD, Stackpool GJ, Hacking SA, Tanzer M, Krygier JJ (1999) Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br Vol 81(5):907–914

    Article  CAS  Google Scholar 

  9. Bobyn JD, Poggie RA, Krygier JJ, Lewallen DG, Hanssen AD, Lewis RJ, Unger AS, O'Keefe TJ, Christie MJ, Nasser S, Wood JE, Stulberg SD, Tanzer M (2004) Clinical validation of a structural porous tantalum biomaterial for adult reconstruction. J Bone Joint Surg Am 86-A(Suppl 2):123–129

    Article  Google Scholar 

  10. Veillette CJ, Mehdian H, Schemitsch EH, McKee MD (2006) Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head. J Bone Joint Surg Am 88(Suppl 3):48–55. https://doi.org/10.2106/JBJS.F.00538

    Article  PubMed  Google Scholar 

  11. Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, Urbaniak JR (2003) Osteonecrosis of the hip: management in the 21st century. Instr Course Lect 52:337–355

    PubMed  Google Scholar 

  12. Varitimidis SE, Dimitroulias AP, Karachalios TS, Dailiana ZH, Malizos KN (2009) Outcome after tantalum rod implantation for treatment of femoral head osteonecrosis: 26 hips followed for an average of 3 years. Acta Orthop 80(1):20–25

    Article  PubMed  PubMed Central  Google Scholar 

  13. Aldegheri R, Taglialavoro G, Berizzi A (2007) The tantalum screw for treating femoral head necrosis: rationale and results. Strategies Trauma Limb Reconstruction 2(2–3):63–68. https://doi.org/10.1007/s11751-007-0021-9

    Article  CAS  Google Scholar 

  14. Liu B, Sun W, Yue D, Li Z, Guo W (2013) Combined tantalum implant with bone grafting for the treatment of osteonecrosis of the femoral head. J Investig Surg : Off J Acad Surg Res 26(3):158–162. https://doi.org/10.3109/08941939.2012.718409

    Article  Google Scholar 

  15. Shuler MS, Rooks MD, Roberson JR (2007) Porous tantalum implant in early osteonecrosis of the hip: preliminary report on operative, survival, and outcomes results. J Arthroplast 22(1):26–31. https://doi.org/10.1016/j.arth.2006.03.007

    Article  Google Scholar 

  16. Zhang X, Wang J, Xiao J, Shi Z (2016) Early failures of porous tantalum osteonecrosis implants: a case series with retrieval analysis. Int Orthop 40(9):1827–1834. https://doi.org/10.1007/s00264-015-3087-x

    Article  PubMed  Google Scholar 

  17. Ma J, Sun W, Gao F, Guo W, Wang Y, Li Z (2016) Porous tantalum implant in treating osteonecrosis of the femoral head: still a viable option? Sci Rep 6:28227. https://doi.org/10.1038/srep28227

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Hur J, Lee HJ, Nam JE, Kim YJ, Kim TH, Choe KO, Choi BW (2009) Diagnostic accuracy of CT fluoroscopy-guided needle aspiration biopsy of ground-glass opacity pulmonary lesions. AJR Am J Roentgenol 192(3):629–634. https://doi.org/10.2214/AJR.08.1366

    Article  PubMed  Google Scholar 

  19. Wallace MJ, Krishnamurthy S, Broemeling LD, Gupta S, Ahrar K, Morello FA Jr, Hicks ME (2002) CT-guided percutaneous fine-needle aspiration biopsy of small (< or =1-cm) pulmonary lesions. Radiology 225(3):823–828. https://doi.org/10.1148/radiol.2253011465

    Article  PubMed  Google Scholar 

  20. Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH (2006) Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am 88(Suppl 3):35–40. https://doi.org/10.2106/JBJS.F.00535

    Article  PubMed  Google Scholar 

  21. Sakagoshi D, Kabata T, Umemoto Y, Sakamoto J, Tomita K (2010) A mechanical analysis of femoral resurfacing implantation for osteonecrosis of the femoral head. J Arthroplast 25(8):1282–1289. https://doi.org/10.1016/j.arth.2009.09.002

    Article  Google Scholar 

  22. Wang Q, Zhang H, Li Q, Ye L, Gan H, Liu Y, Wang H, Wang Z (2015) Biocompatibility and osteogenic properties of porous tantalum. Exp Ther Med 9(3):780–786. https://doi.org/10.3892/etm.2015.2208

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Floerkemeier T, Thorey F, Daentzer D, Lerch M, Klages P, Windhagen H, von Lewinski G (2011) Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. Int Orthop 35(4):489–495. https://doi.org/10.1007/s00264-009-0940-9

    Article  PubMed  Google Scholar 

  24. Liu Y, Su X, Zhou S, Wang L, Wang C, Liu S (2015) A modified porous tantalum implant technique for osteonecrosis of the femoral head: survivorship analysis and prognostic factors for radiographic progression and conversion to total hip arthroplasty. Int J Clin Exp Med 8(2):1918–1930

    PubMed  PubMed Central  Google Scholar 

  25. Oh KJ, Pandher DS (2010) A new mode of clinical failure of porous tantalum rod. Indian J Orthop 44(4):464–467. https://doi.org/10.4103/0019-5413.69322

    Article  PubMed  PubMed Central  Google Scholar 

  26. Floerkemeier T, Lutz A, Nackenhorst U, Thorey F, Waizy H, Windhagen H, von Lewinski G (2011) Core decompression and osteonecrosis intervention rod in osteonecrosis of the femoral head: clinical outcome and finite element analysis. Int Orthop 35(10):1461–1466. https://doi.org/10.1007/s00264-010-1138-x

    Article  PubMed  Google Scholar 

  27. Liu WG, Wang SJ, Yin QF, Liu SH, Guan YJ (2012) Biomechanical supporting effect of tantalum rods for the femoral head with various sized lesions: a finite-element analysis. Chin Med J 125(22):4061–4065

    PubMed  Google Scholar 

  28. Fernandez-Fairen M, Murcia A, Iglesias R, Sevilla P, Manero JM, Gil FJ (2012) Analysis of tantalum implants used for avascular necrosis of the femoral head: a review of five retrieved specimens. J Appl Biomater Funct Mater 10(1):29–36. https://doi.org/10.5301/JABFM.2012.9273

    Article  PubMed  Google Scholar 

  29. Levine BR, Sporer S, Poggie RA, Della Valle CJ, Jacobs JJ (2006) Experimental and clinical performance of porous tantalum in orthopedic surgery. Biomaterials 27(27):4671–4681. https://doi.org/10.1016/j.biomaterials.2006.04.041

    Article  PubMed  CAS  Google Scholar 

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Author information

Author notes

  1. Ruyin Hu and Pengfei Lei contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopeadics, People’s Hospital of Guizhou Province, No. 83 Zhongshan East Road, Guiyang, 550002, Guizhou, People’s Republic of China

    Ruyin Hu, Bo Li & Xiaobin Tian

  2. Department of Orthopeadics, Xiangya Hospital Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, People’s Republic of China

    Pengfei Lei, Xucheng Yang, Ting Wen & Yihe Hu

  3. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Hao Liu

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  1. Ruyin Hu
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  2. Pengfei Lei
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  4. Hao Liu
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Correspondence to Yihe Hu or Xiaobin Tian.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical review committee statement

This study was approved by the ethic committee of Xiangya Hospital Central South University and followed the Declaration of Helsinki. Informed consent were received from all patients.

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Hu, R., Lei, P., Li, B. et al. Real-time computerised tomography assisted porous tantalum implant in ARCO stage I-II non-traumatic osteonecrosis of the femoral head: minimum five-year follow up. International Orthopaedics (SICOT) 42, 1535–1544 (2018). https://doi.org/10.1007/s00264-018-3899-6

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  • DOI: https://doi.org/10.1007/s00264-018-3899-6

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