Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIA Tianwei , WEI Wei , ZHANG Chao , JI Wenhui ,  SHEN Jirong

Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China;

Corresponding?author：

SHEN Jirong, Email: joint66118@sina.com

Keywords：

Avascular necrosis of the femoral head; China-Japan Friendship Hospital Classification; staging treatment; hip preservation; experience

DOI：

10.7507/1002-1892.201904075

Video：

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Objective To sum up staging treatment experiences of hip preservation for avascular necrosis of the femoral head (ANFH) according to China-Japan Friendship Hospital Classification (CJFH Classification).Methods The literature about hip preservation of ANFH was extensively reviewed, and a staging treatment method for ANFH was set up base on CJFH Classification and the 28 years of clinical experience in this research group.Results According to CJFH Classification, the ANFH can be rated as types M, C, and L. And the type L is rated as L1, L2, and L3 subtypes. The staging treatment method for ANFH based on CJFH Classification is set up. Conservative treatment was selected for CJFH-M patients because the necrotic area is small and in the medial non-weight-bearing area. Minimally invasive sequestrum clearance, impacting bone graft, and supporting allogenic fibular graft is selected for CJFH-C patients because the necrotic area is also small and in the lateral non-weight-bearing area. If patients are in CJFH-L1, normal bone area is less than 1/3 on hip abduction radiograph, the sequestrum clearance and impacting bone graft via surgical hip dislocation approach can be selected. If patients are in CJFH-L1, normal bone area is more than 1/3 on hip abduction radiograph, the transtrochanteric curved varus osteotomy can be selected. The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is for CJFH-L2 patients. Total hip arthroplasty via direct anterior approach is for CJFH-L3 patients.Conclusion The staging treatment method for ANFH according to CJFH Classification has good short-term effectiveness. But the long-term effectiveness needs further follow-up.

Citation： XIA Tianwei, WEI Wei, ZHANG Chao, JI Wenhui, SHEN Jirong. Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 10-15. doi: 10.7507/1002-1892.201904075 Copy

1.	Kaushik AP, Das A, Cui Q. Osteonecrosis of the femoral head: An update in year 2012. World J Orthop, 2012, 3(5): 49-57.
2.	Marker DR, Seyler TM, McGrath MS, et al. Treatment of early stage osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90(Suppl 4): 175-187.
3.	杜斌, 孫魯寧, 沈計榮, 等. 微創死骨清除打壓植骨腓骨支撐配合中藥補腎活血湯治療早中期股骨頭壞死的臨床報道. 中華關節外科雜志 (電子版), 2013, 7(3): 404-407.
4.	Fairbank AC, Bhatia D, Jinnah RH, et al. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg (Br), 1995, 77(1): 42-49.
5.	Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg, 2010, 130(7): 859-865.
6.	Aoyama T, Fujita Y, Madoba K, et al. Rehabilitation program after mesenchymal stromal cell?transplantation?augmented by vascularized?bone?grafts for idiopathic?osteonecrosis?of the femoral head: a preliminary study. Arch Phys Med Rehabil, 2015, 96(3): 532-539.
7.	Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
8.	Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
9.	Zhao G, Yamamoto T, Motomura G, et al. Radiological outcome analyses of transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head at a mean follow-up of 11 years. J Orthop Sci, 2013, 18(2): 277-283.
10.	Scheider W, Algner N, Pinggera O, et al. Intertrochanteric osteotomy for avascular necrosis of the femoral head of the femur. Survival probability of two different methods. J Bone Joint Surg (Br), 2002, 84(6): 817-824.
11.	Lieberman JR, Engstrom SM, Meneghini RM, et al. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res, 2012, 470(2): 525-534.
12.	Ficat RP, Arlet J. Necrosis of the femoral head//Hungerford DS, ed. Ischemia and necrosis of bone. Baltimore: Williams & Wilkins, 1980: 171-182.
13.	Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br), 1995, 77(1): 34-41.
14.	Gardeniers JW. A new international classification of osteonecrosis of the ARCO Committee on terminology and classification. J Jpn Orthop Assoc, 1992, 66(2): S18-S19.
15.	Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
16.	李子榮, 劉朝暉, 孫偉, 等. 基于三柱結構的股骨頭壞死分型—中日友好醫院分型. 中華骨科雜志, 2012, 32(6): 515-520.
17.	Pauwels F. The place of osteotomy in the operative management of osteoarthritis of the hip. Triangle, 1968, 8(6): 196-210.
18.	Hasegawa Y, Yamaguchi J, Kanoh T, et al. Low signal intensity area by magnetic resonance imaging that disappeared after a curved intertrochanteric varus osteotomy for traumatic osteonecrosis of the femoral head. J Orthop Sci, 2008, 13(3): 265-268.
19.	施樂, 樊燕鑫, 張超, 等. 虛擬現實技術術前規劃在經轉子間弧形內翻截骨術治療成人股骨頭缺血性壞死中的應用價值. 中國修復重建外科雜志, 2019, 33(8): 923-928.
20.	Yao C, Yi N, Shen J, et al. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade ⅢA-ⅢB aseptic necrosis of femoral head (ANFH) patients. Oncotarget, 2017, 8(30): 50084-50090.
21.	夏天衛, 魏偉, 劉金柱, 等. 經外科脫位入路打壓植骨術與旋轉截骨術治療 ARCO Ⅲ期股骨頭缺血性壞死療效比較. 中國修復重建外科雜志, 2019, 33(4): 445-450.
22.	Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res, 1978, (130): 191-201.
23.	Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis. Follow-up statistics. Clin Orthop Relat Res, 1982, (169): 115-126.
24.	Dean MT, Cabanela ME. Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. J Bone Joint Surg (Br), 1993, 75(4): 597-601.
25.	Chughtai M, Piuzzi NS, Khlopas A, et al. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J, 2017, 99-B(10): 1267-1279.

1. Kaushik AP, Das A, Cui Q. Osteonecrosis of the femoral head: An update in year 2012. World J Orthop, 2012, 3(5): 49-57.
2. Marker DR, Seyler TM, McGrath MS, et al. Treatment of early stage osteonecrosis of the femoral head. J Bone Joint Surg (Am), 2008, 90(Suppl 4): 175-187.
3. 杜斌, 孫魯寧, 沈計榮, 等. 微創死骨清除打壓植骨腓骨支撐配合中藥補腎活血湯治療早中期股骨頭壞死的臨床報道. 中華關節外科雜志 (電子版), 2013, 7(3): 404-407.
4. Fairbank AC, Bhatia D, Jinnah RH, et al. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg (Br), 1995, 77(1): 42-49.
5. Wang BL, Sun W, Shi ZC, et al. Treatment of nontraumatic osteonecrosis of the femoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg, 2010, 130(7): 859-865.
6. Aoyama T, Fujita Y, Madoba K, et al. Rehabilitation program after mesenchymal stromal cell?transplantation?augmented by vascularized?bone?grafts for idiopathic?osteonecrosis?of the femoral head: a preliminary study. Arch Phys Med Rehabil, 2015, 96(3): 532-539.
7. Zeng YR, He S, Feng WJ, et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop, 2013, 37(3): 391-398.
8. Hamanishi M, Yasunaga Y, Yamasaki T, et al. The clinical and radiographic results of intertrochanteric curved varus osteotomy for idiopathic osteonecrosis of the femoral head. Arch Orthop Trauma Surg, 2014, 134(3): 305-310.
9. Zhao G, Yamamoto T, Motomura G, et al. Radiological outcome analyses of transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head at a mean follow-up of 11 years. J Orthop Sci, 2013, 18(2): 277-283.
10. Scheider W, Algner N, Pinggera O, et al. Intertrochanteric osteotomy for avascular necrosis of the femoral head of the femur. Survival probability of two different methods. J Bone Joint Surg (Br), 2002, 84(6): 817-824.
11. Lieberman JR, Engstrom SM, Meneghini RM, et al. Which factors influence preservation of the osteonecrotic femoral head? Clin Orthop Relat Res, 2012, 470(2): 525-534.
12. Ficat RP, Arlet J. Necrosis of the femoral head//Hungerford DS, ed. Ischemia and necrosis of bone. Baltimore: Williams & Wilkins, 1980: 171-182.
13. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg (Br), 1995, 77(1): 34-41.
14. Gardeniers JW. A new international classification of osteonecrosis of the ARCO Committee on terminology and classification. J Jpn Orthop Assoc, 1992, 66(2): S18-S19.
15. Sugano N, Atsumi T, Ohzono K, et al. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci, 2002, 7(5): 601-605.
16. 李子榮, 劉朝暉, 孫偉, 等. 基于三柱結構的股骨頭壞死分型—中日友好醫院分型. 中華骨科雜志, 2012, 32(6): 515-520.
17. Pauwels F. The place of osteotomy in the operative management of osteoarthritis of the hip. Triangle, 1968, 8(6): 196-210.
18. Hasegawa Y, Yamaguchi J, Kanoh T, et al. Low signal intensity area by magnetic resonance imaging that disappeared after a curved intertrochanteric varus osteotomy for traumatic osteonecrosis of the femoral head. J Orthop Sci, 2008, 13(3): 265-268.
19. 施樂, 樊燕鑫, 張超, 等. 虛擬現實技術術前規劃在經轉子間弧形內翻截骨術治療成人股骨頭缺血性壞死中的應用價值. 中國修復重建外科雜志, 2019, 33(8): 923-928.
20. Yao C, Yi N, Shen J, et al. Clinical reports of surgical dislocation of the hip with sequestrum clearance and impacting bone graft for grade ⅢA-ⅢB aseptic necrosis of femoral head (ANFH) patients. Oncotarget, 2017, 8(30): 50084-50090.
21. 夏天衛, 魏偉, 劉金柱, 等. 經外科脫位入路打壓植骨術與旋轉截骨術治療 ARCO Ⅲ期股骨頭缺血性壞死療效比較. 中國修復重建外科雜志, 2019, 33(4): 445-450.
22. Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res, 1978, (130): 191-201.
23. Sugioka Y, Katsuki I, Hotokebuchi T. Transtrochanteric rotational osteotomy of the femoral head for the treatment of osteonecrosis. Follow-up statistics. Clin Orthop Relat Res, 1982, (169): 115-126.
24. Dean MT, Cabanela ME. Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. Long-term results. J Bone Joint Surg (Br), 1993, 75(4): 597-601.
25. Chughtai M, Piuzzi NS, Khlopas A, et al. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J, 2017, 99-B(10): 1267-1279.

Chinese Journal of Reparative and Reconstructive Surgery

Hip preservation experience of avascular necrosis of femoral head according to China-Japan Friendship Hospital classification

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