Treatment of osteonecrosis of femoral head with bioceramic rod combined with bone morphogenetic protein

doi:10.3877/cma.j.issn.1674-134X.2026.02.014

Abstract

Abstract:

Objective

To evaluate the clinical efficacy of bioceramic rod combined with recombinant human bone morphogenetic protein (rh-BMP) in the treatment of osteonecrosis of the femoral head (ONFH) at Association Research Circulation Osseuse (ARCO) stages Ⅱ and Ⅲ in young and middle-aged patients.

Methods

A total of 26 patients with ONFH admitted to the Department of Joint Surgery, the 940th Hospital of the Joint Logistics Support Force from January 2018 to June 2021 were enrolled. All the patients underwent bioceramic rod implantation combined with rh-BMP grafting. Preoperative and postoperative imaging findings, numerical rating scale (NRS) scores for pain, and Harris hip scores at preoperative and the last follow-up were recorded. Paired-samples t test was used for the comparison of indicators before and after surgery. Differences were considered statistically significant when P<0.05.

Results

The follow-up duration was 10 to 26 months, (18.0±1.6) months on average. The hip preservation rate was 92.8% (26/28) at the last follow-up. The NRS reduced from (4.07±0.26) to (1.50±0.92) (t=14.181, P<0.001) and the Harris hip score elevated from (60.00±6.24) to (85.54±11.81) (t=-10.116, P<0.001). Hip preservation failed in two patients, who subsequently underwent total hip arthroplasty (THA). Postoperative dynamic contrast-enhanced MRI showed good blood flow signals in the bone graft and bioceramic rod implantation areas in all the patients.

Conclusion

Core decompression combined with bioceramic rod implantation achieves reliable short-term efficacy in the treatment of ONFH at ARCO stages Ⅱ and Ⅲ, and the therapeutic effect is more prominent in patients with ARCO stage Ⅱ ONFH.

Key words: Ceramics, Femur head necrosis, Minimally invasive surgical procedures, Decompression, surgical

Xiaoyang Song, Hong Han, Shenghu Zhou, Yongjie Qiao, Haoqiang Zhang, Lirong Sha, Jinpeng Lou, Peng Liu, Zhenhao Liu, Qifeng Song. Treatment of osteonecrosis of femoral head with bioceramic rod combined with bone morphogenetic protein[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 242-247.

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Figures/Tables 7

Table 1 Comparison of preoperative and postoperative scores in patients with ONFH

时间 Time	NRS	Harris髋关节评分 Harris hip score
术前 Before surgery	4.07±0.26	60.00±6.24
术后 After surgery	1.50±0.92	85.54±11.81
t值	14.181	10.116
P值	<0.001	<0.001

Table 2 Comparison of postoperative blood supply excellent and good rate between ARCO stage Ⅱand Ⅲ

分期 Stage	例数 Case number	优 Excellent	良 Good	可 Fair	差 Poor	优良率（%）Excellent and good rate
Ⅱ期	21	12	7	2	0	90.5
Ⅲ期	7	4	1	0	2	71.4
P值						<0.001^a

Figure 1 X ray image of pelvis at anteroposterior view three months after hip preservation surgery for left femoral head osteonecrosis, showing uneven density of the femoral head, satisfactory position of the implanted ceramic rod, and ceramic resorption at the ceramic rod–femoral neck interface

Figure 2 X ray image of pelvis at anteroposterior view 10 months after hip preservation surgery for right femoral head osteonecrosis，showing good morphology of right femoral head, strip-like radiolucency in the right intertrochanteric region, and almost complete resorption of the ceramic rod

Figure 3 X ray image of pelvis at anteroposterior view 17 months after hip preservation surgery for right femoral head osteonecrosis, showing a smooth femoral head contour, clear trabecular bone architecture, and complete resorption of the ceramic rod with favorable bone formation

Figure 4 Dynamic contrast-enhanced MRI blood flow signals in the operative area of the affected side at ARCO stage Ⅱafter hip preservation surgery Note: A is the selection of three regions of interest (ROIs) , including bone graft area (area one), ceramic rod tunnel area (area two), normal area (area three); B to C are blood flow signals comparison among the three ROIs before contrast, showing significantly higher signals in areas two and one compared to area three; D to E are blood flow signals comparison after contrast, demonstrating higher signals in areas two and one compared to area three

Figure 5 Blood flow signals in dynamic contrast-enhanced MRI of ARCO stage Ⅲ hip preservation surgery Note: A is the selection of three regions of interest (ROIs) , including bone graft area (area one), ceramic rod tunnel area (area two), normal area (area three); B is blood-flow-signal comparison among the three ROIs before contrast, showing significantly higher signals in areas two and one compared to area three; C is blood-flow-signal comparison after contrast, demonstrating higher signals in areas two and one compared to area three

References 12

［1］	Roth A, Tingart M. Atraumatische femurkopfnekrose des Erwachsenen［J］. Oper Orthopädie Und Traumatol, 2020, 32（2）: 87-88.
［2］	Tan B, Li W, Zeng P, et al. Epidemiological study based on China osteonecrosis of the femoral head database［J］. Orthop Surg, 2021, 13（1）: 153-160.
［3］	Kang JS, Moon KH, Kwon DG, et al. The natural history of asymptomatic osteonecrosis of the femoral head［J］. Int Orthop, 2013, 37（3）: 379-384.
［4］	朱诗白, 张啸天, 陈曦, 等. 股骨头坏死的保髋治疗［J/OL］. 中华关节外科杂志（电子版）, 2020, 14（6）: 741-746.
［5］	Choi H-R, Steinberg ME, Y Cheng E. Osteonecrosis of the femoral head: diagnosis and classification systems［J］. Curr Rev Musculoskelet Med, 2015, 8（3）: 210-220.
［6］	Dorozhkin SV. Bioceramics of calcium orthophosphates［J］. Biomaterials, 2010, 31（7）: 1465-1485.
［7］	Lu J, Wang QY, Sheng JG, et al. A 3D-printed, personalized, biomechanics-specific beta-tricalcium phosphate bioceramic rod system: personalized treatment strategy for patients with femoral shaft non-union based on finite element analysis［J/OL］. BMC Musculoskelet Disord, 2020, 21（1）: 421. DOI: 10.1186/s12891-020-03465-1.
［8］	Osawa Y, Seki T, Takegami Y, et al. Collapse progression or cessation affects the natural history of contralateral osteonecrosis of the femoral head［J］. J Arthroplasty, 2021, 36（12）: 3839-3844.
［9］	Migliorini F, Maffulli N, Baroncini A, et al. Prognostic factors in the management of osteonecrosis of the femoral head: a systematic review［J］. Surgeon, 2023, 21（2）: 85-98.
［10］	Cohen-Rosenblum A, Cui Q. Osteonecrosis of the femoral head［J］. Orthop Clin N Am, 2019, 50（2）: 139-149.
［11］	鲁亚杰, 王臻, 卢霄, 等. 生物陶瓷系统微创治疗ARCO Ⅱ、Ⅲ期股骨头坏死［J］. 中国修复重建外科杂志, 2019, 33（10）: 1291-1298.
［12］	Lim H-K, Hong S-J, Byeon S-J, et al. 3D-printed ceramic bone scaffolds with variable pore architectures［J/OL］. Int J Mol Sci, 2020, 21（18）: 6942. DOI: 10.3390/ijms21186942.

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