New Method for the Treatment of Early Forms of Femoral Head Aseptic Necrosis (Preliminary Report)

The authors have elaborated a new method for conservative treatment of femoral head aseptic necrosis (FHAN) at early stages of the disease (prior to cartilaginous layer collapse). The method consists of performance of prolonged epidural analgesia by administration of local anesthetic through epidural catheter with dosed speed for 6 - 8 days. Drug sympathectomy results in vascular tension drop that favours the improvement of microcirculation in hip joint region. Results of that method application in 24 patients show that it enables to cup off the pain syndrome and restore patient's functional abilities directly after treatment course completion. Remission lasts for up to 12 months. Application of the proposed method enables to postpone performance of total hip arthroplasty for the period of up to 6 years.

Download Full-text

COMBINED IMPACTION AUTOPLASTY OF THE FEMORAL HEAD IN THE TREATMENT OF PATIENTS WITH EARLY STAGES OF ASEPTIC NECROSIS

Science and Innovations in Medicine ◽

10.35693/2500-1388-2017-0-3-39-44 ◽

2017 ◽

Vol 2 (3) ◽

pp. 39-44

Author(s):

DS S Kudashev ◽

SD D Zuev-Ratnikov ◽

IS S Shorin

Keyword(s):

Femoral Head ◽

Pain Syndrome ◽

Pathological Process ◽

Diagnostic Methods ◽

New Method ◽

Harris Hip Score ◽

Aseptic Necrosis ◽

Early Stages ◽

Functional Capabilities ◽

Results Of Treatment

Aseptic necrosis of the femoral head refers to the number of severe, rapidly progressing destructive-dystrophic hip joint lesions. In the overwhelming majority of cases, the disease develops in young and most active age group. In the absence of necessary treatment, the result of the disease is the early disability retirement with the need for radical reconstructive interventions on the joint. The use of modern diagnostic methods makes it possible to detect the beginning of the pathological process in the femoral head in the early stages and to conduct the most effective treatment of patients of this category. Aim - to improve the results of treatment of patients with early stages of aseptic necrosis of the femoral head due to the development and introduction into clinical practice of a new method of combined impaction autoplasty of the femoral head. Materials and methods. A new method of combined impaction autoplasty of the femoral head was used, including decompression, intraosseous resection and excision of the focus of osteonecrosis followed by combined autoplasty of the postresection defect (RF patent No. 2583577 dated 13.04.2016). Intraosseous resection of the focus of destruction of the femoral head was performed with the help of a specially developed device - milling cutters for bone tissue resection (RF patent for utility model No. 171951 dated 21.06.2017). Evaluation of the effectiveness of the treatment was carried out on the basis of the severity of the pain syndrome and functional capabilities of patients defined by the Harris scale (Harris Hip Score). Results. The analysis of the medium-term results of the conducted treatment showed that good results were obtained in 67.4% of cases in which the proposed method was used.

Download Full-text

Epidemiological Study of Femoral Head Osteonecrosis

Revista de Chimie ◽

10.37358/rc.17.5.5593 ◽

2017 ◽

Vol 68 (5) ◽

pp. 974-976

Author(s):

Alexandru Patrascu ◽

Liliana Savin ◽

Dan Mihailescu ◽

Victor Grigorescu ◽

carmen Grierosu ◽

...

Keyword(s):

Risk Factors ◽

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Young Patients ◽

Head Group ◽

Bipolar Hemiarthroplasty ◽

Aseptic Necrosis ◽

Total Hip ◽

Femoral Head Osteonecrosis

In recent years, there has been an increase in the number of studies on the etiology of femoral head necrosis. We retrospectively reviewed all patients diagnosed with aseptic necrosis of the femoral in the period of 2010-2015. We recorded a total of 230 cases diagnosed with aseptic necrosis of the femoral head, group was composed of 65.7% men and 34.3% women, risk factors identified was 19.13% (post-traumatic), 13.91% (glucocorticoids), 26.52% (alcohol), 3.47% (another cause) and in 36 95% of the cases no risk factors were found. The results of the study based on the type of surgery performed on the basis of stages of disease progression, 8 patients (3.48%) benefited from osteotomy, 28 patients (12.17%) benefited of bipolar hemiarthroplasty prosthesis and 188 patients (81.74%) benefited of total hip arthroplasty. Osteonecrosis of the femoral head is characteristic to young patients between the age of 30-50 years old. Predisposing factors, alcohol and corticosteroid therapy remains an important cause of the disease. Total hip arthroplasty remains the best option for the patients with osteonecrosis of the femoral head.

Download Full-text

Use of Perfotran at Conservative Treatment of Early Stages of Femoral Head Avascular Necrosis

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201522426-31 ◽

2015 ◽

Vol 22 (4) ◽

pp. 26-31

Author(s):

V. M Prokhorenko ◽

A. G Shusharin ◽

M. P Polovinka

Keyword(s):

Femoral Head ◽

Conservative Treatment ◽

Avascular Necrosis ◽

Pain Syndrome ◽

Harris Hip Score ◽

Treatment Results ◽

Early Stages ◽

Reduction Of Pain ◽

Group 2

Conservative treatment results are presented for 328 patients with I-II stages of femoral head avascular necrosis (FHAN) at 3 years follow up term. Uni- or bilateral coxarthrosis was observed in 157 patients. Patients were on intraarticular injections of perfotran (1st group; n=102) or perfotran+dimexide mixture (2nd group; n=226). Clinical and functional hip joint condition was evaluated by Harris Hip Score. Positive dynamics was noted in all patients however in group 2 it was more marked: absence of negative dynamics was recorded in 204 (90.2%) patients; restorative process, by MRI examination results, was noted in 105 (46.5%) patients; significant reduction of pain syndrome was achieved. Algorithm for the management of patients with early stages of FHAN was proposed.

Download Full-text

OSOBENNOSTI LEChENIYa POVREZhDENIY TARANNOY KOSTI

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200310146-50 ◽

2003 ◽

Vol 10 (1) ◽

pp. 46-50

Author(s):

N A Koryshkov ◽

O V Zaytsev

Keyword(s):

Conservative Treatment ◽

Sagittal Plane ◽

Pain Syndrome ◽

Long Term Results ◽

Medial Malleolus ◽

Moderate Pain ◽

Stable Fixation ◽

Aseptic Necrosis ◽

Diagnosis Accuracy

The experience in diagnosis and treatment of 52 talus injuries (50 patients) is presented. Inclusion of computer tomography into examination complex allowed to improve the diagnosis accuracy, especially in fractures of talus body and talus blocking in sagittal plane. Eight (16%) patients underwent conservative treatment and 42 (84%) were operated on. Surgical dissection of medial malleolus provides anatomic (preservation of artery deltoideus) and vast approach for the revision of fracture zone. Reposition performed at the early terms as well as stable fixation of talus fragments by sunken metal-devices are the means for the compensation of vascular disturbances (aseptic necrosis). In case of moderate pain syndrome, development of small aseptic necrosis zones and absence of talus prolapse active vascular therapy and delayed tactics are indicated. In marked pain syndrome, vascular disturbances, significant aseptic necrosis of talus with its prolapse the indications to the resection astragalectomy should be considered. Long term results were observed in 43 patients. Good results were achieved in 36 (83.7%) and satisfactory results - in 7 (16.3%) patients.

Download Full-text

Conservative treatment of aseptic necrosis of the femoral head in adults (literature review)

Genij Ortopedii ◽

10.18019/1028-4427-2020-26-4-585-592 ◽

2020 ◽

Vol 26 (4) ◽

pp. 585-592

Author(s):

V.V. Lobashov ◽

◽

A.V. Zainutdinov ◽

I.F. Akhtyamov ◽

◽

...

Keyword(s):

Femoral Head ◽

Conservative Treatment ◽

Functional State ◽

Early Stage ◽

Joint Damage ◽

Complete Recovery ◽

Lipid Lowering ◽

Aseptic Necrosis ◽

Level Of Evidence ◽

Treatment Methods

Introduction Aseptic necrosis of the femoral head (ANFH) is one of the orthopedic diseases affecting the socially active population. This fact determines the keen interest of researchers in this nosological type. At present, there is no consensus on the ANFH etiology and pathogenesis, what complicates the choice of treatment tactics. The efficiency of conservative treatment, despite the existence of several options, is currently controversial. The reasons for this remain the ambiguity of research results associated with a low level of evidence, heterogeneity of patients samples, different approaches to studying the efficacy of various treatment methods. The aim of this work is to analyze studies of a high level of evidence on the effectiveness of the use of conservative methods in the treatment of ANFH. Material and methods The study reviews the studies published between 2010 and 2017 (61) available in various information systems (PubMed, eLibrary.ru, etc.). Results The data from the studies of evidence levels I and II showed the ineffectiveness of using the method of joint unloading and lipid-lowering agents in the treatment of patients with ANFH. The use of anticoagulants in idiopathic (primary) ANFH in the pre-collapse stage was justified. The effectiveness of biophysical methods (hyperbaric oxygenation, extracorporeal shockwave therapy and pulsed electromagnetic fields) and cell therapy was confirmed in terms of relieving pain, improving the functional state of the joint and metabolic processes in it at the early stage of the disease. The efficacy of the drug iloprost in eliminating pain and edema in patients with ANFH at an early stage was proven. The opinions of researchers about the effect of bisphosphonates on the results of treatment in patients with ANFH are controversial. Conclusion There is insufficient evidence to prove the effectiveness of any of the conservative treatment methods, but there are studies proving their partial effectiveness. Complete recovery of the joint, as a rule, does not occur, but in most cases it is possible to prevent joint damage, reduce destructive processes in the femoral head and pain, and maintain the functional state of the muscles.

Download Full-text

Uncemented total hip arthroplasty in patients with aseptic necrosis of the femoral head and previous bone grafting

The Journal of Arthroplasty ◽

10.1016/s0883-5403(06)80101-4 ◽

1993 ◽

Vol 8 (1) ◽

pp. 1-6 ◽

Cited By ~ 18

Author(s):

Margaret J. Fehrle ◽

John J. Callaghan ◽

Charles R. Clark ◽

Kirk K. Peterson

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Bone Grafting ◽

Aseptic Necrosis ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty

Download Full-text

Functional state of neuromotor apparatus and microvasculature in patients with femoral head aseptic necrosis

Practical medicine ◽

10.32000/2072-1757-2019-6-53-59 ◽

2019 ◽

Vol 17 (6 (part 2)) ◽

pp. 53-59

Author(s):

A. M. Eremeev ◽

◽

A. A. Shulman ◽

I. F. Akhtyamov ◽

I. I. Shaykhutdinov ◽

...

Keyword(s):

Femoral Head ◽

Functional State ◽

Aseptic Necrosis ◽

Neuromotor Apparatus

Download Full-text

A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0041-1728760 ◽

2021 ◽

Author(s):

Andrew G. Yun ◽

Marilena Qutami ◽

Kory B. Dylan Pasko

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Radiation Exposure ◽

Hip Arthroplasty ◽

Fluoroscopy Time ◽

Lesser Trochanter ◽

Total Hip ◽

Preoperative Templating ◽

The Mean ◽

Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

Download Full-text