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Hemodynamic changes in osteonecrosis treatment of the femoral head with iliac bone flaps pedicled with the lateral femoral circumflex artery ascending branch: A 10-year report

Abstract

BACKGROUND:

Vascularized bone grafting was used in the treatment of osteonecrosis femoral head, which may directly influence the pathologic event of femoral head.

OBJECTIVE:

This paper evaluates hemodynamic changes in osteonecrosis treatment of the femoral head (ONFH) with iliac bone flaps from the lateral femoral circumflex artery ascending branches via digital subtraction angiography.

METHODS:

A total of 48 patients, (31 males and 17 females; 38 at stage II and 10 at stage III), were treated with iliac bone flaps pedicled with the ascending branch of the lateral femoral circumflex artery. DSA was performed on all 48 patients preoperatively and 6 months postoperatively, and 10 years postoperatively on 1 patient.

RESULTS:

Six months after surgery, femoral head blood supplies were distinctly visualized in the selective DSA in 44 cases. 4 patients showed poor or failed vessel pedicle filling in the transplanted bone flaps. Total hip arthroplasty was performed on these 4 patients. DSA was conducted 10 years post-operation in 1 case; the subject showed normal blood supply of the femoral head.

CONCLUSIONS:

The anatomical position of the ascending branch of the lateral femoral circumflex artery was constant. Digital subtraction angiography successfully examined hemodynamic changes in osteonecrosis treatment of the femoral head with vascularized bone flaps.

References

[1] 

Jones LC, , Hungerford DS. The pathogenesis of osteonecrosis. Instr Course Lect. 2007; 56: 179-96.

[2] 

Jones Jr JP. Concepts of etiology and early pathogenesis of osteonecrosis. Instr Course Lect. 1994; 43: 499-512.

[3] 

Matsuo K, , Hirohata T, , Sugioka Y, , Ikeda M, , Fukuda A. Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res. 1988 Sep; (234): 115-23.

[4] 

Nishimura T, , Matsumoto T, , Nishino M, , Tomita K. Histopathologic study of veins in steroid treated rabbits. Clin Orthop Relat Res. 1997 Jan; (334): 37-42.

[5] 

Nagi ON, , Dhillon MS, et al. Open reduction, internal fixation and fibular autografting for neglected fracture of the femoral neck. J Bone Joint Surg (Br). 1998; 80-B: 794-804.

[6] 

Protzman RD, , Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg (Am). 1976; 58-A: 689-95.

[7] 

Moya-Angeler J, , Gianakos AL, , Villa JC, , Ni A, , Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015; 6(8): 590-601.

[8] 

Mont MA, , Einhorn TA, , Sponseller PD, , Hungerford DS. The trapdoor procedure using autogenous cortical and cancellous bone grafts for osteonecrosis of the femoral head. J Bone Joint Surg. 1998; 80B: 56-62.

[9] 

Mont MA, , Etienne G, , Ragland PS. Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2003; 417: 84-92.

[10] 

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

[11] 

Mont MA, , Marulanda GA, , Jones LC, , Saleh KJ, , Gordon N, , Hungerford DS, , Steinberg ME. Systematic analysis of classification systems for osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006; 88 Suppl 3: 16-26.

[12] 

Aldridge JM, , Urbaniak JR. Avascular necrosis of the femoral head: etiology, pathophysiology, classification, and current treatment guidelines. Am J Orthop (Belle Mead NJ). 2004; 33: 327-332.

[13] 

Lavernia CJ, , Sierra RJ, , Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop Surg. 1999; 7: 250-261.

[14] 

Judet H, , Gilbert A. Long-term results of free vascularized fibular grafting for femoral head necrosis. Clin Orthop Relat Res. 2001; 386: 114-119.

[15] 

Rosenwasser MP, , Garino JP, , Kiernan HA, , Michelsen CB. Long term follow-up of thorough debridement and cancellous bone grafting of the femoral head for avascular necrosis. Clin Orthop Relat Res. 1994; 306: 17-27.

[16] 

Urbaniak JR, , Coogan PG, , Gunneson EB, , Nunley JA. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: A long-term follow-up study of one hundred and three hips. J Bone Joint Surg. 1995; 77A: 681-694.

[17] 

Hungerford M, , Shirley E, , Khanuja P, , Hungerford D. Osteotomies as treatment for osteonecrosis. Curr Opin Orthop. 2003; 14: 17-22.

[18] 

Rosenwasser MP, , Garino JP, , Kiernan HA, , Michelsen CB. Long term follow-up of thorough debridement and cancellous bone grafting of the femoral head for avascular necrosis. Clin Orthop Relat Res. 1994; 306: 17-27.

[19] 

Berend KR, , Gunneson EE, , Urbaniak JR. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. J Bone Joint Surg. 2003; 85A: 987-993.

[20] 

Buckley PD, , Gearen PF, , Petty RW. Structural bone grafting for early atraumatic avascular necrosis of the femoral head. J Bone Joint Surg. 1991; 73A: 1357-1364.

[21] 

Zhao D, , Xu D, et al. Iliac Grate Vascularization for Femoral Head Osteonecrosis. Clin Orthoped Relat Res. 2006; 442: 171-179.

[22] 

Zhao Dewei, , Yu xiaobing, , Wang Benjie, et al. Digital subtraction angiography in selection of the vascularized greater trochanter bone grafting for treatment of osteonecrosis of femoral head. Microsurgery. 2013 Nov; 33(8): 656-659.

[23] 

Zhao D, et al. Vascularized periosteum, the bone and vascular bundle implantation to repair bone defects in rabbits. Chinese J Orthop. 1998; 18(5): 299-302.

[24] 

Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end result study using a new method of result evaluation. J Bone Jo int Surg (Am). 1969; 51(4): 737-755.

[25] 

Zhao D, , Wang W, et al. Applied anatomy for transposition of two periosteal flaps pedicled with iliac crest and anterior inferior iliac branches of ascending rarus of lateral femoral circumflex vesses. Chinese J Orthop. 1998e; 18(5): 298-302.

[26] 

Bozic KJ, , Zurakowski D, , Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg. 1999; 81A: 200-209.

[27] 

Hasegawa Y, , Iwata H, , Torii S, et al. Vascularized pedicle bonegrafting for nontraumatic avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 1997; 116: 251-258.

[28] 

Zhao Dewei, , Sui Guangzhi, , Du Guojun, et al. Vascularized bone flap transfer of large rotor head of the treatment of different diseases [J]. Chinese J Orthop. 1995; 15(9): 591-593.

[29] 

Starklint H, , Lausten GS, , Arnoldi CC. Microvascular obstruction in avascular necrosis Immunohistochemistry of 14 femoral heads. Acta Orthop Scand. 1995 Feb; 66(1): 9-12.