The medium-term clinical efficacy of autogenous bone, allogeneic bone and bone morphogenetic protein-2 in the avascular necrosis of the femoral head

Abstract

Objective \nTo evaluate the medium-term clinical efficacy of autogenous bone, allogeneic bone and bone morphogenetic protein-2 with core decompression in the treatment of osteonecrosis of the femoral head (ONFH). \n \n \nMethods \nThirty-five patients (44 hips) with stage Ⅱ or ⅢA of ONFH according to the system of the association research circulation osseous (ARCO) were included in this study. All the patients underwent core decompression with implantation of the mixture of autogenous bone, allogeneic bone and bone morphogenetic protein-2. The mean age at surgery was (19-64) (43.4±15.3) years and the mean period of follow-up 5.2 (4-6) years. X-ray films were taken at the follow-ups. Harris scores system was recorded before and after operation to evaluate clinical effects of surgery.Statisticalanalysis of data using the statistical product and service solutions 22.0 software. \n \n \nResults \nAt the last follow-up, postoperative Harris hip scores (78.6±12.9) were significantly higher than those (66.2±12.7) before operation (t=5.96, P<0.01) and the rate of excellent and good results was 70.5%. In the patients of ARCO ⅡA and ⅡB, the rate of excellent and good results was 86.4%, and that was 59.1% in the patients of ARCO ⅡC and ⅢA. The hip survival rate was 83.3% in patients (12 hips) under 40 years of age, and 68.8% in patients (32 hips) over 40 years of age. \n \n \nConclusion \nThe implantation of the mixture of autogenous bone, allogeneic bone and bone morphogenetic protein-2 with core decompression appears to confer benefits in the treatment of in stages Ⅱ-ⅢA ONFH at medium-term follow-up. It seems that the patients in stages ARCO ⅡA-ⅡB or those under 40 years of age can get better results by this treatment of ONFH. \n \n \nKey words: \nFemoral head necrosis;\xa0Decompressive surgery;\xa0Bone grafting;\xa0Tissue engineering;\xa0Recombinant human morphogenetic protein-2