Outcomes of the conservative hip preservation treatment in patients with osteonecrosis of the femoral head: With 4-year follow-up

Abstract

BACKGROUND

Osteonecrosis of the femoral head (ONFH) is a prevalent clinical condition, and as the affected population becomes younger and more widespread, an increasing number of patients prefer to retain their own hip joints. In comparison to joint replacement and hip-preserving surgeries, conservative hip preservation treatment is gaining more recognition from both clinicians and patients.

AIM

To observe the clinical efficacy and influencing factors of conservative hip preservation treatment for patients with ONFH.

METHODS

A total of 73 patients (119 hips) were included, and patients were grouped based on Association Research Circulation Osseous (ARCO) stage, Japanese Investigation Committee (JIC) classification, lesion size, and collapse degree. The clinical efficacy of conservative hip preservation treatment was evaluated from two aspects: Radiological progression and clinical functional scores [Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), international Hip Outcome Tool 12 (iHOT-12), and visual analogue scale (VAS)]. Analyzing the success rate of conservative hip preservation based on conversion to total hip arthroplasty or hip preservation surgery.

RESULTS

In this retrospective cohort study, we retrospectively analyzed 73 patients (119 hips) with an average follow-up time of 53.58 ± 26.80 (18-129) months. The overall success rate of hip preservation is 90.76%. The success rates of hip preservation in ARCO I-II, IIIa, and IIIb were 97.67%, 91.53%, and 70.59%, respectively (P < 0.05). The success rates of hip preservation for JIC A-B, C1, and C2 were 93.37%, 92.59%, and 77.78%, respectively (P < 0.05). The success rates of hip preservation with collapse degree ≤ 2 mm and > 2 mm were 94.12% and 70.59%, respectively (P < 0.05). There was no significant difference in the success rate of hip preservation between different lesion sizes. In terms of clinical function, the Harris Hip Score, WOMAC, iHOT-12, and VAS scores at the last follow-up were significantly better than before treatment (P < 0.05). The VAS scores of ARCO IIIa and IIIb were significantly worse than those of ARCO I and II (P < 0.05). The iHOT-12, WOMAC, and VAS scores were significantly better with the lesion size < 15% (P < 0.05). In terms of radiological results, there was significant progress in ARCO staging and collapse degree after conservative hip preservation treatment, but there was no significant difference in JIC classification and lesion size.

CONCLUSION

Conservative hip preservation treatment can effectively treat ONFH, prevent the progression of the necrosis, and significantly improve the clinical function of patients. The radiological staging and lesion size at the initial visit may help determine the prognosis of conservative hip preservation treatment.

Keywords: Hip preservation treatment; Conservative; Osteonecrosis of the femoral head; Survival with collapse; Nonsurgical

Core Tip: The clinical efficacy of conservative hip preservation treatment has always been a vague concept. This study reviewed 119 hips with an average follow-up time of 4 years (including the longest 10 years), and demonstrated through radiological findings and clinical functional scores that conservative hip preservation treatment can achieve certain long-term good therapeutic effects. It may contribute to enhancing hip joint function and postponing the need for arthroplasty.