Surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade IIIA or IIIB aseptic necrosis of femoral head patients

Objective To analyze the therapeutic effect of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade ⅢA or ⅢB aseptic necrosis of femoral head(ANFH) patients. Methods From June 2012 to December 2014, 6 patients(8 hips) of grade ⅢA or ⅢB ANFH patients were retrospectively followed. In the 6 patients, 3 were males with 5 hips and 3 were females with 3 hips. The mean age of the patients was 36 years (range from 26 to 44 years). All the patients were dealt with surgical dislocation of the hip with sequestrum clearance and impacting bone graft. Collapse of the femoral head, healing of the osteotomy, and Harris hip scores were observed after surgeries, and Harris scoring criteria was used to assess efficacy at postoperative 6 months. Results All the patients were successfully operated and totally followed up. The average time of follow up was 16.8 (4-34) months. One patient with 1 hip suffered from unreasonable fever and pain around the surgical site 2 months after surgery. He was given anti-inflammatory treatment and the symptoms were totally relieved. One patient with 1 hip had more than 4 mm collapse of femoral head and had pain and movement restriction. He is now preparing for total his replacement. All of the other osteotomies were healed. Harris hip scores were improved from (54.57±8.16) points to (80.53±7.62) points and the difference was statistically significant(t=12.797, P<0.01). The efficacy was assessed 6 months after surgery: excellent in 4 patients with 5 hips; good in 1 patient with 2 hips and bad in 1 patient with 1 hip. Conclusions For grade ⅢA or ⅢB ANFH patients, surgical dislocation with sequestrum clearance and impacting bone graft can obtain good therapeutic effect. It is especially a choice for young patients. Key words: Femur head necrosis; Aseptic necrosis of femoral head; Impacting bone graft