Implantation of hydroxyapatite methylmethacylate cement in the treatment of osteonecrosis of femoral head: a medium-term evaluation of the results / 中华骨科杂志

ABSTRACT

Objective To introduce a method using hydroxyapatite methylmethacylate cement implanted in the femoral head for the treatment of patients suffering from avascular necrosis of the femoral head due to different causes and to review the medium term follow up results. Methods From January 1990 to December 1995, eight hips in seven patients(male 4, female 3) with femoral head necrosis at Ficat stage Ⅲ were treated with the hydroxyapatite methylmethacylate cement implantation in the involved femoral head. Four osteonecrosis were secondary to femoral neck fracture, two were due to corticosteroid intake and one had alcohol abuse history. All patients complained pain and limited joint activity. The operation consisted of the removal of necrotic bone under weight loading cartilage with curet and the implantation of the hydroxyapatite methylmethacylate cement. The function of hip joint were well evaluated and X ray films were taken pre and postoperatively. The average postoperative follow up was 7.9 years, ranging from 5.1 to 11 years. Results Merle d Aubign? method was used to assess and compare the pre and post operative function of hip joint. The average score for unilateral cases increased from 8.66 to 15.5 at final examination. On radiography, the improvement of the contours of the femoral head was seen in all patients and most of them could preserve their initial postoperative contours during the follow up. No sign of expansion of the bone necrosis appeared in most of the patients, although certain patients presented various joint degeneration such as narrowing of joint space,sclerosis and osteophyte. Subjective evaluation was satisfactory except two suffering from painless limited activity of hip joint. Conclusion This method is relatively simple with less invasion and rapid postoperative recovery. It may be a choice of surgery for the treatment of certain femoral head necrosis at Ficat stage Ⅲ, especially for young patients.