Pericollapse Stage of Osteonecrosis of the Femoral Head: A Last Chance for Joint Preservation

Zhang, Qing-Yu; Li, Zi-Rong; Gao, Fu-Qiang; Sun, Wei

Replacing the necrotic bone of the femoral head with cancellous or cortical bone grafting via a window (light bulb technique) at the femoral neck base or decompression tracts (Phemister technique) aims to achieve necrotic area decompression and provide strong structural support for lesion healing and subchondral bone rebuilding. Compared with CD alone, NVBG is more suitable for ONFH at the pericollapse stage. [49, [57] [58] [59] In Steinberg et al.'s [60] study, for lesions in Steinberg Stage III, CD combined with autologous bone grafting could decrease the need for THA from 82% to 23%, while the joint-preserving rate in Steinberg IV is only approximately 50%. Zuo et al. [61] reported that the clinical failure rates of the light bulb technique in patients at ARCO Stage II and IIIa were 25.9% and 16.2%, respectively, and as high as 61.5% at ARCO Stage III (b + c).