One-sided hip-preserving and concurrent contralateral total hip arthroplasty for the treatment of bilateral XXXX of the femoral head in different stages: short-medium term outcomes.

@entity1 @entity135 @entity39 @entity158 @entity2530
BACKGROUND: We aimed to evaluate the clinical and radiological short-medium term outcomes for the treatment of bilateral @entity2530 of the femoral head (ONFH) with hip-preserving surgery of core decompression followed by tightly impaction bone grafting combining with non-vascularized fibular allografting in one hip and concurrent one-stage total hip arthroplasty (THA) in the contralateral side. We hypothesized the aforementioned surgery showed benefits of protecting the preserved hip from collapsing and thereafter THA was delayed or avoided. METHODS: We retrospectively reviewed a consecutive series of 18 non-traumatic bilateral ONFH @entity1 (36 hips) who had undergone previous mentioned surgeries between July 2004 and June 2013. Preoperative and the last follow-up Harris Hip Score (HHS) and Visual Analogue Scale (VAS) Score were obtained for clinical outcomes evaluation and X-rays of antero-posterior and frog-leg lateral views of bilateral hips were compared for radiological outcomes assessment. RESULTS: All @entity1 were telephone contacted for out- @entity1 clinic return visit at an average follow-up time of 53.3  months (ranged from 20  months to 107  months). Of the 18 @entity1 (15 @entity1 and 3 @entity1 ), there were 5 @entity1 were diagnosed preoperative IIB stages according to classification of the Association Research Circulation Osseuse classification (ARCO) and the remaining 13 @entity1 were in ARCO IIIC stages. The mean age of the included @entity1 was 40.7  years (range from 22 to 59  years). No age and followed-up time difference existed in genders. The postoperative HHS were 83.8        17.9 points, and it revealed statistical significance when compared to preoperative 61.6        17.0 points (p   <   0.05). The VAS scores were reduced from preoperative 6.2        2.0 points to postoperative 2.8        2.3 points, which also manifested outcomes significance (p   <   0.05). From radiological aspects, 14 @entity1 acquired well repairmen of the @entity39 areas of the femoral head. However, the other 4 @entity1 ultimately suffered femoral @entity135 , and the severe @entity158 was gotten rid of after THA surgeries were performed. CONCLUSIONS: The un-collapsed hip can achieve biological stability and sufficient blood supply through the hip-preserving surgery and obtain longtime repairmen of the @entity39 bone as well as early non-weight-bearing function training, which benefits from distributing the whole body weight load to the hip of one-stage THA. Consequently, we recommend this sort of surgery for clinical practice trial when faced bilateral ONFH in different stages though longer time follow-up and larger samples are essentially needed to address its efficacy.
