scholarly journals Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis

2016 ◽  
Vol 118 (1) ◽  
pp. 33-49 ◽  
Author(s):  
Francesco Sadile ◽  
Alessio Bernasconi ◽  
Sergio Russo ◽  
Nicola Maffulli
Keyword(s):  
Femoral Head ◽  
Meta Analysis ◽  
Core Decompression

scholarly journals The efficacy and safety of core decompression for the treatment of femoral head necrosis: a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Kun-chi Hua ◽  
Xiong-gang Yang ◽  
Jiang-tao Feng ◽  
Feng Wang ◽  
Li Yang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Radiographic Progression ◽  
Meta Analysis ◽  
Core Decompression ◽  
Femoral Head Necrosis ◽  
Significant Difference ◽  
Autologous Bone ◽  
Necrosis Of Femoral Head ◽  
Rate Of Success

Abstract Background Core decompression (CD) is an important method for the treatment of osteonecrosis of the femoral head (ONFH). Few articles investigate the influence of core decompression on outcomes of ONFH. This study was carried out to observe the safety and effectiveness of core decompression in the treatment of ONFH. Methods A comprehensive literature search of databases including PubMed, Embase, and Cochrane Library was performed to collect the related studies. The medical subject headings used were “femur head necrosis” and “Core decompression.” The relevant words in title or abstract included but not limited to “Osteonecrosis of the Femoral Head,” “femoral head necrosis,” “avascular necrosis of femoral head,” and “ischemic necrosis of femoral head.” The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Results Thirty-two studies included 1865 patients (2441 hips). Twenty-one studies (1301 hips) using Ficat staging standard, 7 studies (338hips) using Association Research Circulation Osseous (ARCO) staging standard, and University of Pennsylvania system for staging avascular necrosis (UPSS) staging criteria for 4 studies (802 hips). All the studies recorded the treatment, 22 studies (1379 hips) were treated with core decompression (CD) alone, and 7 studies (565 hips) were treated with core decompression combined with autologous bone (CD Autologous bone). Nine subjects (497 hips) were treated with core decompression combined with autologous bone marrow (CD Marrow). Twenty-seven studies (2120 hips) documented the number of conversion to total hip replacement (THA), and 26 studies (1752hips) documented the number of radiographic progression (RP). Twenty-one studies recorded the types of complications and the number of cases, a total of 69 cases. The random-effect model was used for meta-analysis, and the results showed that the overall success rate was 65%. The rate of success showed significant difference on the outcomes of different stages. The rate of success, conversion to THA, and radiographic progression showed significant difference on the outcomes of ONFH using different treatments. Conclusions Core decompression is an effective and safe method of treating ONFH. The combined use of autologous bone or bone marrow can increase the success rate. For advanced femoral head necrosis, the use of CD should be cautious. High-quality randomized controlled trials and prospective studies will be necessary to clarify the effects of different etiology factors, treatments, and postoperative rehabilitation. Until then, the surgeon can choose core decompression to treat ONFH depending on the patient’s condition. Level of evidence I Meta-analysis

scholarly journals Autologous Stem Cells Combined Core Decompression for Treatment of Avascular Necrosis of the Femoral Head: A Systematic Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Shibing Xu ◽  
Lei Zhang ◽  
Hongting Jin ◽  
Letian Shan ◽  
Li Zhou ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Meta Analysis ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Bone Marrow Stem Cells ◽  
Harris Hip Score ◽  
Autologous Bone

Objective. This study aims to systematically evaluate the efficacy and safety of core decompression combined transplantation of autologous bone marrow stem cells (CDBMSCs) for treatment of avascular necrosis of the femoral head (ANFH). Methods. Randomized controlled trials (RCTs) regarding effectiveness of core decompression combined transplantation of autologous bone marrow stem cells for treating ANFH were searched in 8 comprehensive databases prior to September 2016. The data analysis was performed by using the RevMan version 5.3. Results. A total of 11 studies with 507 participants were included. Results showed that CDBMSCs group was more effective than CD group in increasing Harris hip score, decreasing necrotic area of femoral head, collapse of femoral head, and conversion to total hip replacement incidence. In the subgroup analysis, the results did not change in different intervention measure substantially. In addition, the safety of CDBMSCs for ANFH is reliable. Conclusion. Based on the systematic review, our findings suggest that core decompression combined transplantation of autologous bone marrow stem cells appeared to be more efficacious in the treatment at early stages of ANFH.

scholarly journals Effect of Platelet-rich Plasma Combined With Core Decompression Bone Grafting for Osteonecrosis of Femoral Head: A Meta-Analysis

2021 ◽  
Author(s):  
QiZhong Lai ◽  
Kaishen Cai ◽  
Tianye Lin ◽  
Peng Yang ◽  
Binglang Xiong ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Bone Grafting ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Core Decompression ◽  
Osteonecrosis Of Femoral Head ◽  
Group A ◽  
Group B ◽  
Better Than

Abstract Objective: Core decompression bone grafting usually is used hip-preserving approach for osteonecrosis of femoral head (ONFH). Platelet-rich plasma (PRP) is an adjuvant therapy, combined with core decompression bone grafting for ONFH. However, it remains controversial. Therefore, its efficacy was systematically evaluated and meta-analysis in this study.Methods: Literature on core decompression bone grafting for ONFH was retrieved in CNKI, Wan Fang, PubMed, Embase, Cochrane Library and Web of Science from inception to March 2021. Review Manager 5.3 software and Stata 12.0 software were used for data synthesis.Results: A total of 10 RCTs were included. The results showed at final follow-up that, Harris hip score was significantly difference in the treatment group, adjuvant therapy with PRP (group A) better than the control group (group B), MD=7.53 [95%CI (5.29,9.77)]，P < 0.00001. There was MD=-0.71[95%CI (-0.96, -0.46)], P < 0.00001, of visual analog scale (VAS) of hip pain between the two groups. The excellent and good rate of function of hip was 1.42-fold higher in group A than that in group B, RR=1.42, 95%CI (1.25,1.62), P<0.00001. The progression and total hip arthroplasty were showed improvements, RR=0.37,95%CI (0.21,0.65), P=0.0006 and RR=0.39,95%CI (0.18,0.85), P=0.02, respectively. Begg's and Egger's tests did not indicate publication bias.Conclusion: It was shown that the use of PRP combined with core decompression bone grafting improved the symptoms better than core decompression bone grafting only, and might delay progression and total hip arthroplasty. However, as the study’s limitations, it needed to be fully verified by more large-sample multicenter prospective clinical studies.

scholarly journals Combination use of core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis using Forest and Funnel Plots

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Linghanqing Wang ◽  
XuRong Tian ◽  
Keda Li ◽  
Chunlei Liu
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Femoral Head ◽  
Meta Analysis ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Bone Marrow Stem Cell ◽  
Femoral Head Necrosis ◽  
Autologous Bone ◽  
Marrow Stem Cell

Problem statement. Core decompression (CD) is a very significant process of dealing in the treatment of femoral head necrosis. And CD combined with bone marrow mesenchymal stem cell transplantation has been widely used in clinical practice, but its effectiveness is controversial. This study is carried out to observe its efficacy and outcomes. Objective. This study evaluated the efficacy and safety of CD combined with bone marrow stem cells in the treatment of femoral head necrosis by systematic review and meta-analysis. Methodology. PubMed, The Cochrane Library, Embase, CNKI, Google Scholar and MEDLINE, etc. databases were searched for clinical randomized controlled trials (RCTs) comparing core decompression combined with autologous bone marrow mesenchymal stem cells versus core decompression alone in the treatment of femoral head necrosis. The retrieval period is from the establishment of each database to May 20, 2021. After literature was extracted and literature quality was evaluated, meta-analysis was conducted by using RevMan5.3 software. Results. A total of 420 osteonecrosis of the femoral head 452 patients' data were collected from all studies. Compared with the core decompression alone group, the CD combined with bone marrow stem cell showed marked reduction in the Visual analog scale (VAS), enhanced Harris hip score (HHS) at 12 months and 24 months, slowed down the progression of the disease, decreased the number of hips conversed to total hip arthroplasty (THA) in the future. Conclusion. Core decompression therapy is a very effective and safe treatment process used for ONFH. Moreover, CD combined autologous bone marrow stem cell transplantation can improve the survival rate of the necrotic head, reduce hip pain and delay the disease progression, the rate of THA postoperatively.

scholarly journals What are the outcomes of core decompression in patients with avascular necrosis? Protocol for a systematic review

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 71 ◽  
Author(s):  
Octavian Andronic ◽  
Haitham Shoman ◽  
Ori Weiss ◽  
Vikas Khanduja
Keyword(s):  
Systematic Review ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Meta Analysis ◽  
Core Decompression ◽  
Cochrane Library ◽  
Decompression Surgery ◽  
Surgical Methods ◽  
Staging Systems ◽  
Augmentation Techniques

Background: Core decompression is a hip preserving surgical procedure that is used to treat avascular necrosis (AVN) of the femoral head. The eventual clinical and radiological outcome following this procedure is varied in literature. Also, the time to a total hip replacement (THR) from the index procedure and the percentage of patients subsequently undergoing a THR is controversial. Furthermore, there are multiple surgical methods along with multiple augmentation techniques and various classification and staging systems described. The purpose of this systematic review, therefore, is to analyse the outcomes following decompression only, excluding any augmentation techniques for non-traumatic AVN of the femoral head. Methods: This protocol is being developed in line with the PRISMA-P guidelines. The search strategy includes articles from Medline, Embase, Google Scholar, CINHAL and Cochrane library. The review and screening will be done by two independent reviewers. Review articles, editorials and correspondences will be excluded. Articles including patients with sickle cell disease and with core decompression where augmentation is used will be excluded. The risk of bias and quality of articles will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for the different study designs included. Discussion: This study will be a comprehensive review on all published articles having patients with AVN of the femoral head and undergoing core decompression surgery only. The systematic review will then define the outcomes of the core decompression surgery based on clinical and radiological outcomes. Each outcome will include the different stages within it and finally, the total mean time to THR will be calculated. This will then be followed by assessing the cumulative confidence in evidence from all the data collected using the GRADE tool.   Registration: This systematic review is registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42018100596

scholarly journals The Effect of Extracorporeal Shock Wave on Osteonecrosis of Femoral Head: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Jin Mei ◽  
Lili Pang ◽  
Yu Gong ◽  
Zhongchao Jiang
Keyword(s):  
Shock Wave ◽  
Femoral Head ◽  
Meta Analysis ◽  
Core Decompression ◽  
Visual Analogue Score ◽  
Harris Hip Score ◽  
Lesion Area ◽  
China National Knowledge Infrastructure ◽  
Osteonecrosis Of Femoral Head ◽  
Extracorporeal Shock Wave

Abstract Background: This study aimed to determine whether ESWT (extracorporeal shock wave therapy) has an efficient effect on ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes.Method: Two authors independently searched the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database) , Pubmed, Embase and Springer databases. Search period from the inception dates to June 2, 2020 and have no limitations in language; Two authors independently conducted Quality evaluation and data extraction for included studies and preformed a meta-analysis with data extracted and calculated by using review manager 5.3.Result: Nine articles with 409 patients were included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieved higher Harris scores compared to before treatment (MD= -19.95;95% CI: -26.27, -13.64;). The differences were statistically significant (p<0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieved lower VAS compared to baseline (MD= 2.77;95%CI: 1.88, 3.65;), the differences were statistically significant (p<0.01). the pooled results of lesion of MRI with 164 hips show that ESWT decrease the lesion area of MRI (SMD=1.03,CI: 0.75,1.30,),the differences were statistically significant (p<0.01).Conclusion: ESWT have an effect in pain relief and can improve motion function. It's effect better than surgical groups (core decompression and core decompression with bone grafting). But it may not decrease the lesion area of the femoral head on MRI.

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