Evidence for Using Synthetic Bone Grafts for the Treatment of Osteonecrosis of the Femoral Head: A Systematic Review of the Literature and Meta-analysis.
Description
Background: Synthetic bone grafts (SBG) potentially add structural stability after core decompression (CD) for osteonecrosis of the femoral head (ONFH). This systematic review and meta-analysis assessed the evidence supporting the (1) clinical efficacy, (2) radiographic efficacy; (3) revision rates, and (4) safety of CD and CD with SBG for the treatment of ONFH. Methods: A total of 6,549 papers were screened. Inclusion criteria were met by 25 studies for CD and by 16 studies for CD+SBG. This study included 1,929 hips with ONFH – 1,256 treated with CD, 499 treated with CD+SBG, and 174 treated with CD+SBG with adjuvant therapies (CD+SBG+ADJ). Results: The clinically defined failure rate (CF) was 50% for CD, 22% for CD+SBG and 13% for CD+SBG+ADJ with significantly lower CF in CD+SBG than in the CD group (p=0.02). The radiographic progression (RP) was 47% for CD, 32% for CD+SBG, and 28% for CD+SBG+ADJ with no differences between subgroups (p=0.12). The mean total hip arthroplasty (THA) conversion rate was 39% for CD, 23% for CD+SBG and 19% for CD+SBG+ADJ with a significantly lower THA conversion rate in the CD+SBG (p<0.01) and CD+SBG+ADJ (p=0.02) groups than in the CD group. The complication rates were 7.4% for CD and 2.2% for CD+SBG and CD+SBG+ADJ groups combined. When comparing studies from the same period (after year 2000), there were no significant differences between the three groups in THA conversion rate (p=0.14), RP (p=0.58), and CF (p=0.35). Conclusion: There is no clear evidence that adding synthetic bone grafts to a core decompression produces better results than core decompression alone when comparing studies from the same period.