Abstract:

Osteonecrosis of the femoral head (ONFH) is a common orthopedic disease in China, and it is also the first major cause of total hip arthroplasty (THA) in China. There are many early treatment methods for ONFH, including conservative treatment and surgical treatment, but the long-term clinical effects of different treatment modalities have not been reported in the literature. The treatment of ONFH has been influenced by many factors such as patients′ and physicians′ perception of the disease. The principles of hip preservation surgery mainly include ONFH decompression, removal of necrotic bone, bone grafting in necrotic area, structural bone support of subchondral bone, vascular bone transplantation, intertrochanteric osteotomy, etc. There are three evaluation methods for ONFH efficacy evaluation, including clinical effect evaluation system, imaging evaluation, and final clinical outcome evaluation. At present, it is considered that the grade of evidence for clinical effect of various conservative treatment of ONFH is doubtful, and the grade of evidence of various hip preservation surgery methods is also different. In the treatment of early ONFH, the approach of decompression and bone grafting via greater trochanter plus structural bone support has obvious advantages in terms of minimal invasive surgery, strong repeatability, operability, easy to master surgical techniques, positive clinical effects, especially long-term effects.

Key words: Femur head necrosis, Surgical procedures, minimally invasive, Arthroplasty, replacement, hip, Hip preservation surgery, Efficacy evaluation