Comparison of minimally-invasive fibular supporting of T-type with traditional bloody iliac flap metastasis for osteonecrosis of the femoral head at ARCO stage II

Biomechanical and clinically controlled study of different fenestration positions in vascularized iliac bone flaps for treating femoral head necrosis

BACKGROUND

No appropriate studies have been conducted that compare the biomechanical properties of different fenestration positions in deep circumflex iliac artery (DCIA)-vascularized iliac bone grafts for femoral head necrosis (ONFH) treatment. In this study, we aimed to explore the fenestration locations of DCIA-vascularized iliac grafting in ONFH treatment using FEA and clinical retrospective analysis.

METHODS

We simulated an iliac bone flap transplantation with a vascularized tip by finite element analysis (FEA). Patients were divided into four groups using different femur fenestration positions as follows: center-window group (C-group), superior-window group (S-group), medial-window group (M-group), and inferior-window group (I-group). In this study, we primarily observed the maximum femoral stress at different healing degrees (0, 25, 50, 75, and 100%). We retrospectively analyzed the changes in the postoperative Harris scores (HHS) and the imaging of 16 patients with iliac flaps for ONFH (11 and 5 cases in the center and other-positioned groups, respectively) at the final follow-up visit.

RESULTS

The FEA results showed that the peak von Mises stresses in the four groups at the time of complete healing were in the following order: group C (20.28 MPa) < group I (20.33 MPa) < group M (20.92 MPa) < group S (22.00 MPa). A clinical retrospective study following a comparison of the two groups found that the mean improvement in HHS was 18.00 ± 12.38 in the center-window group and 13.60 ± 25.55 in the other groups. However, no significant difference was observed in the rate of collapse (36.37 vs. 40.00%) or changes in the HHS between the two groups.

CONCLUSION

A fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes.

TRIAL REGISTRATION

approval was granted by the Ethics Committee (II202418102).

Comparative analysis of surgical interventions for osteonecrosis of the femoral head: a network meta-analysis of randomized controlled trials

BACKGROUND

Despite several surgical options, there remains no consensus regarding the optimal approach for osteonecrosis of the femoral head (ONFH), a prevalent and refractory disease. To determine the most suitable treatment modality, we compared randomized controlled trials (RCTs) that evaluated multiple surgical treatments for ONFH using a Bayesian network meta-analysis (NMA).

METHODS

The outcomes of 11 different surgical treatments were assessed using NMA comparisons of the rate of progression of femoral head necrosis, the rate of conversion to total hip arthroplasty, and improvement of the Harris hip score (HHS). A random effects model was used to analyze the odds ratio (OR) or mean difference, and risk of bias was assessed using the Cochrane risk of bias assessment tool for randomized trials. The confidence of the results was assessed using the confidence in network meta-analysis tool.

RESULTS

A total of 18 RCTs were included in the meta-analysis. Compared with core decompression (CD), the forest plot showed that autologous bone grafting (ABG), free fibula grafting (FFG), vascularized bone grafting (VBG), autologous bone grafting combined with bone marrow aspirate concentrate (ABG + BMAC), and biomaterial grafting combined with vascularized bone grafting (BMG + VBG) delayed ONFH progression. Among them, ABG + BMAC showed the most promising results (OR 0.019; 95% confidence interval [CI] 0.0012-0.25). However, upon comparing CD with different surgical modalities, no significant differences were found in preventing total hip arthroplasty. Furthermore, we cannot draw conclusions regarding the HHS due to attribution and high heterogeneity across the studies.

CONCLUSION

Overall, ABG, VBG, FFG, ABG + BMAC, and BMG + VBG showed significant results in preventing ONFH progression compared with that shown by CD. Based on the surface under the cumulative ranking, ABG + BMAC was the most effective. Moreover, all treatments involving bone grafting were found to be effective, possibly indicating the necessity of its use in the treatment of ONFH.

Systematic analysis of hip-preserving treatment for early osteonecrosis of the femoral head from the perspective of bibliometrics (2010-2023)

BACKGROUND

Osteonecrosis of the femoral head (ONFH) is a serious condition that causes bone tissue death, femoral head collapse, and hip joint destruction. Early intervention through hip-preserving treatment is crucial to slow down disease progression, preserve hip joint function, and improve the quality of life of patients. We analyzed the knowledge map, research gaps, and future research directions in the field of hip-preserving treatment for early ONFH.

METHODS

All publications related to hip-preserving treatment for early ONFH published between 2010 and 2023 were identified from the Web of Science Core Collection and analyzed using VOSviewer 1.6.19, CiteSpace 6.2.R2, and Scimago Graphica 1.0.35.

RESULTS

In total, 234 articles were analyzed. The results showed an exponential growth trend in the number of publications related to hip-preserving treatment for early ONFH in the past decade. China and the USA were the main contributors. International Orthopaedics published the most papers in this field, whereas Bone and Joint Surgery-American Volume had the highest average citation count per article. Several stable research topics were noted in this field, including core decompression (CD), osteotomy, bone transplantation in hip-preserving surgery, and cell therapy, which have become research hotspots in hip-preserving treatment.

CONCLUSIONS

Hip-preserving treatment for early ONFH has received increasing attention, and research in this field is expected to grow. Stable research topics include core decompression (CD), osteotomy, bone transplantation, and cell therapy. Future research is predicted to focus on cell therapy and combination therapy, resulting in an increasing number of publications on hip-preserving treatment for early ONFH.