scholarly journals Single approach to double-channel core decompression and bone grafting with structural bone support for treating osteonecrosis of the femoral head in different stages

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Ju’an Yue ◽  
Xiaozhong Guo ◽  
Randong Wang ◽  
Bing Li ◽  
Qiang Sun ◽  
...  
Keyword(s):  
Femoral Head ◽  
Bone Grafting ◽  
Core Decompression ◽  
Double Channel ◽  
Single Approach

Outcomes and indications of the single approach to double-channel core decompression and bone grafting with structural bone support for osteonecrosis of the femoral head

2021 ◽  
Author(s):  
Ju’an Yue ◽  
Xiaozhong Guo ◽  
Randong Wang ◽  
Bing Li ◽  
Qiang Sun ◽  
...  
Keyword(s):  
Femoral Head ◽  
Bone Grafting ◽  
Early Stage ◽  
Core Decompression ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Femoral Head Collapse ◽  
Double Channel ◽  
Single Approach

Abstract BackgroundTo report the outcomes of the single approach to double-channel core decompression and bone grafting with structural bone support (SDBS) for osteonecrosis of the femoral head (ONFH) and define the indications.MethodsOne-hundred-and-thirty-nine hips in 96 patients (79 males, 17 females; mean age 37.53±10.31 years, range 14–58 years; mean body mass index 25.15±3.63 kg/m2) were retrospectively analysed. The Harris hip score (HHS) was used to assess hip function, and radiographs were used to assess the depth of femoral head collapse. Treatment failure was defined as the performance of total hip arthroplasty (THA). The variables assessed as potential risk factors for surgical failure were: aetiology, Japanese Osteonecrosis Investigation Committee (JIC) type, age, and Association Research Circulation Osseous (ARCO) stage. Complications were recorded.ResultsThe HHS increased from 79.00±13.61 preoperatively to 82.01±17.29 at final follow-up (P=0.041). The average HHS improvement was 3.00±21.86. The combined excellent and good rate at final follow-up (65.6%) was significantly higher than that before surgery (34.5%) (P=0.000). On radiographic evaluation, 103 (74.1%) hips remained stable, while 36 (25.9%) had femoral head collapse or aggravation of ONFH. THA was performed in 18 hips. Thus, the overall femoral head survival rate was 87.05% (121/139). The success rate was adversely affected by JIC type, but not by aetiology, age, or ARCO stage. The only complication was a subtrochanteric fracture in one patient.ConclusionThe SDBS effectively delays or even terminates the progression of ONFH, especially type B and C1. The SDBS is a good option for early-stage ONFH.

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 Robot-assisted core decompression combined with bone grafting can improve the early clinical results in femoral head necrosis: a prospective cohort study

2021 ◽  
Author(s):  
Run Tian ◽  
Sen Luo ◽  
Chunsheng Wang ◽  
Kunzheng Wang ◽  
Pei Yang
Keyword(s):  
Femoral Head ◽  
Bone Grafting ◽  
Core Decompression ◽  
Femoral Head Necrosis ◽  
Robot Assisted ◽  
X Ray ◽  
Surgery Group ◽  
Significant Difference ◽  
Robot Assisted Surgery

Abstract Background: To explore the clinical effect of robot-assisted core decompression combined with bone grafting in the treatment of femoral head necrosis involved in early stage.Methods: This study is a prospective cohort study. The study included 49 patients (78 hips) who attended the Department of Orthopedics and Joint Surgery of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2019 to February 2021. All the patients suffering Association Research Circulation Osseous (ARCO) II stage of femoral head necrosis underwent core decompression and bone grafting. Among the patients undergoing surgery, 30 patients (54 hips) were treated with traditional surgical methods, and 19 patients (24 hips) were assisted by the made-in-China orthopedic robot system. All operations were performed by the same operator. The baseline data of the two groups of patients, the time of unilateral operation, the number of unilateral X-ray fluoroscopy, the Harris hip score (HHS) at the last follow-up after surgery, the visual analog score (VAS), and the collapse rate at the last follow-up were collected and compared. Results: A total of 41 patients (70 hips) were followed up, including 24 cases (42 hips) in the traditional surgery group and 17 cases in the robot-assisted group (28 hips). The average follow-up time of all cases was (13.9±3.4) months (range: 8-18 months). At the last follow-up, a total of 13 patients (13 hips) suffered femoral head surface collapse, including 11 patients in the traditional surgery group (11 hips) and 2 patients in the robot-assisted group (2 hips). The rate of femoral head collapse between the two groups had statistical difference. The average operation time of unilateral hip in the traditional operation group was (22.5±5.5) min, and (18.2±4.0) min in the robot-assisted group, with significant difference. The number of X-ray fluoroscopy of unilateral hip in the traditional operation group was (14.7±3.1) times, and (10.1±3.1) times in the robot-assisted group, with significant difference. The HHS before surgery in the traditional surgery group was (63.8±3.2) points, and (84.6±3.4) points at the last follow-up,while the preoperative HHS of the robot-assisted surgery group was (65.5±3.5) points, and (85.9±3.1) points at the last follow-up. The HHS at the last follow-up of the two groups were significantly different from those before the operation, but there was no difference between the two groups. The preoperative VAS of the traditional surgery group was (4.8±0.8) points, and (1.7±1.2) points at the last follow-up. The preoperative VAS of the robot-assisted surgery group was (5.0±0.7) points, and (0.9±0.7) points at the last follow-up. At the last follow-up of the two groups, there were significant differences in VAS, and significant difference between the two groups was also detected.Conclusion: Core decompression combined with bone grafting have a definite effect in the treatment of femoral head necrosis at early stage. Compared with traditional surgery, robot-assisted surgery can achieve better short-term results and head preservation rate. Trial registration: the research has been registered in China National Medical Research Registration and Filing System

Prophylactic Decompression and Bone Grafting for Small Asymptomatic Osteonecrotic Lesions of the Femoral Head

2011 ◽  
Vol 21 (6) ◽  
pp. 672-677 ◽  
Author(s):  
Jason E. Hsu ◽  
Tristan Wihbey ◽  
Roshan P. Shah ◽  
Jonathan P. Garino ◽  
Gwo-Chin Lee
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Bone Grafting ◽  
Core Decompression ◽  
Surgical Decompression ◽  
Initial Surgery ◽  
Relieve Pain ◽  
Lost To Follow Up ◽  
Mean Time

Core decompression and grafting has been shown to relieve pain and possibly prevent disease progression in patients with symptomatic osteonecrosis (ON) of the hip. However, there is a lack of evidence regarding the management of the asymptomatic hip with femoral head ON. The purpose of this study was to evaluate the outcome of core decompression in the asymptomatic hip with ON. We prospectively followed 37 consecutive patients with MRI confirmed ON of the hips that underwent simultaneous bilateral core decompression and bone grafting. Prior to surgery, only one of the hips was symptomatic, and the main indication for surgical decompression of the asymptomatic side was to prevent disease progression. No hip on the asymptomatic side was staged greater than Steinberg IIB classification. Serial radiographs were followed for evidence of disease progression. Six patients were lost to follow-up prior to two years. The remaining 31 patients were followed for an average of 32.6 months. There were 20 men and 11 women with an average age of 40.6 years. Ten patients with asymptomatic hips at the time of surgical decompression had disease progression requiring THA. The mean time to arthroplasty in this group was 15.1 months. Meanwhile, 13 symptomatic hips at the initial surgery progressed to THA at an average of 12.9 months following core decompression. The proportion of hips requiring conversion to THA was similar between the two groups (p=0.30), and the rate of progression to THA was not significantly faster compared to patients with symptomatic hips who subsequently required THA (p=0.18). Core decompression for asymptomatic ON of the femoral head is unpredictable. Based on our results, asymptomatic ON lesions particularly in the setting of bilateral disease should be closely observed and surgery reserved for when symptoms arise.

scholarly journals Repair of non-traumatic femoral head necrosis by marrow core decompression with bone grafting and porous tantalum rod implantation

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Keyun Peng ◽  
Yu Wang ◽  
Jifeng Zhu ◽  
Chengling Li ◽  
Zimin Wang
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Bone Grafting ◽  
Core Decompression ◽  
The Other ◽  
Femoral Head Necrosis ◽  
Clinical Effects ◽  
Porous Tantalum ◽  
Creative Commons ◽  
Significant Difference

Objective: To compare the clinical effects of marrow core decompression with bone grafting and marrow core decompression with porous tantalum rod implantation in treating avascular necrosis of non-traumatic femoral head. Methods: This prospective study selected 60 patients (74 hips) with avascular necrosis of femoral head admitted to Daping Hospital from January 2018 to March 2019. According to treatment methods, the 60 patients were randomly divided into two groups, i.e. 30 patients in one group were treated by marrow core decompression with bone grafting, and the other 30 patients in the other group were treated with marrow core decompression and porous tantalum rod implantation. Results: All implantation treatments were successful. No significant difference was found in surgical duration, hemorrhage volume and duration of hospitalization stay between the two groups during follow-up. All Harris scores were significantly improved (P<0.05) following treatment compared to those before treatment. The Harris score of patients treated with porous tantalum rod implantation was higher than that of patients treated with bone grafting (P<0.05) after 12 months following treatment and such a difference was significant. Conclusion: The combination of marrow core decompression and porous tantalum rod implantation can better improve the functions of hip joints with early femoral head necrosis than marrow core decompression with bone grafting, and can also prevent articular cartilage from collapsing gradually. doi: https://doi.org/10.12669/pjms.36.6.2176 How to cite this:Peng K, Wang Y, Zhu J, Li C, Wang Z. Repair of non-traumatic femoral head necrosis by marrow core decompression with bone grafting and porous tantalum rod implantation. Pak J Med Sci. 2020;36(6):1392-1396. doi: https://doi.org/10.12669/pjms.36.6.2176 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Hip-preserving surgical treatment for atraumatic femoral head necrosis

2020 ◽  
Vol 26 (4) ◽  
pp. 495-501
Author(s):  
A.E. Murzich ◽  
◽  
O.A. Sokolovsky ◽  
G.A. Uryev ◽  
◽  
...  
Keyword(s):  
Femoral Head ◽  
Minimally Invasive ◽  
Bone Grafting ◽  
Young Patients ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Femoral Head Necrosis ◽  
Long Term Results ◽  
Surgical Interventions ◽  
Femoral Head Osteonecrosis

Introduction Hip-salvage treatment in femoral head necrosis has a great social and economic importance.The number of hip joint replacements in young patients has been increasing. Purpose To evaluate the results of hip-preserving surgical interventions in the treatment of patients with non-traumatic femoral head necrosis. Materials and methods The study included 42 cases treated by minimally invasive core decompression of the femoral head and bone grafting, 22 cases of decompression and introduction of autologous bone marrow and mesenchymal stem cells into the core of necrosis, and six cases of using a titanium locking mesh implant. Results The follow-up time after surgery was up to 5 years. The survival rate of hip-reserving operations using cell technology to stimulate osteoregeneration were noticeably better than using bone grafting only in disease stages I, IIA, IIB, IIC. For femoral head osteonecrosis in stage IIIA, a titanium locking femoral head implant has been developed. It promotes regeneration and performs a supporting function. Conclusion The analysis of long-term results of these minimally invasive technologies has proven their efficacy and safety along with a low rate of complications.

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