Multiple drilling and multiple matchstick-like bone allografts for large osteonecrotic lesions in the femoral head: an a
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ORTHOPAEDIC SURGERY
Multiple drilling and multiple matchstick‑like bone allografts for large osteonecrotic lesions in the femoral head: an average 3‑year follow‑up study Jun‑Ki Moon1 · Jae Youn Yoon1 · Chul‑Ho Kim1 · Sun Hyung Lee2 · Aditya L. Kekatpure1 · Jun Seong Lee1 · Pil Whan Yoon1 Received: 17 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction We aimed to present the clinical outcomes of multiple drilling and multiple matchstick-like bone allograft for large osteonecrotic lesions of the femoral head as a joint-preserving surgery. Materials and methods Between March 2014 and March 2018, 57 patients (77 hips) who underwent multiple drilling and multiple matchstick-like bone allograft for large lesions (≥ 30%) in osteonecrosis of the femoral head (ONFH) were included. Harris hip scores (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were obtained preoperatively and at the latest follow-up. Plain radiographs were obtained every 3 months. Femoral head collapse ≥ 2 mm was defined as a radiological failure, and conversion to total hip arthroplasty (THA) was regarded as a clinical failure. Results After exclusion of 5 patients (5 hips) who lost to follow-up, 52 patients (34 men, 18 women; 72 hips) were finally enrolled. The mean follow-up period was 3.4 (range 2–4.5) years. Nineteen hips (28.4%) required conversion to THA at a mean of 21.6 (range 6–42) months postoperatively. In the remaining 53 hips (71.6%) with clinical success, the mean HHS and WOMAC improved from 63 and 31.3 preoperatively to 80.6 and 16.3 at the final follow-up, respectively (p 18 and 30% of the femoral head) were included. The patients who have inflammatory joint disease or degenerative osteoarthritis of hip were excluded. Between March 2014 and June 2017, 57 patients (77 hips) who underwent multiple drilling with multiple matchstick-like bone allograft met the criteria. All operations were performed by a single senior author. The patient is placed in the supine position on a fracture table without traction. After placing a guide wire in the necrotic area under fluoroscopic guidance, a 6-mm hole was drilled through the greater trochanter base, along the femoral neck and into the necrotic lesion within 5 mm of the subchondral bone. A fibular allograft was split into multiple pieces like a matchstick of 4-cm length and 5-mm diameter. The allograft was inserted into the hole with light hammer
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Fig. 2 a Preoperative 3-dimensional computed tomography image of the left hip of a man aged 21 years with ONFH showing large osteonecrotic lesions sized about 40% of femoral head (white arrow); b Postoperatively, matchstick-like bone allografts placed in radial direction into the osteonecrotic lesion are shown
blow (Fig. 1). Radial direction multiple drillings followed by matchstick-like bone allograft insertion were performed on all patients through a single hole (Fig. 2).
Archives of Orthopaedic and Trauma Surgery
Patient-reported outcome measures were collecte
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