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

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.

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

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.

scholarly journals Conservative treatment of traumatic injuries of the rotatory-bicepital complex

2019 ◽  
Vol 16 (1) ◽  
pp. 7-12
Author(s):  
О. A. Danilenko ◽  
E. R. Makarevich ◽  
N. S. Serdiuchenko
Keyword(s):  
Conservative Treatment ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Regional Hospital ◽  
Long Term Results ◽  
Treatment Results ◽  
Traumatic Injuries ◽  
Treatment Indications

The effectiveness of the developed approaches to the conservative treatment of traumatic injuries of the rotatory-bicepital complex is assessed. The long-term results of conservative treatment of 29 patients for the period from 2004 to 2017 and treated in the Mogilyov regional hospital and the SCTC of the 6th Minsk city clinical hospital were studied. The conservative treatment indications were considered to be the cases with traumatic partial local or extensive injuries of the rotator-bicepital complex in the presence of clinical manifestations in the form of pain syndrome and limitation of limb movements and in the absence of a decrease in limb strength in the sectoral testing of elements. The proposed tactical approaches implied immobilization, physiotherapy, local injection therapy.The developed conservative approaches to treating patients with damage to the rotary element of RBC allowed one to achieve a favorable outcome in the absolute majority of cases with long periods of patient follow-up, which improved the performance evaluation indicators according to the Oxford questionnaire for Me shoulder from 56 [48–58] to 12 [12–32] (Me [Q25–Q75]). The applied conservative approaches to treating patients with damage to the rotary element of RBC are a promising way to improve the clinical treatment results of patients with partial injuries of the rotator-bicepital complex.

scholarly journals Clinical Outcome and Histopathologic Evaluations of Porous Tantalum Implant for the Treatment of Early-Stage Osteonecrosis

2020 ◽  
Author(s):  
Yu Zhang ◽  
Jian-Ning Sun ◽  
Ye Zhang ◽  
Zi-Jian Hua ◽  
Shuo Feng ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Clinical Effect ◽  
Histopathological Examination ◽  
Operation Time ◽  
Harris Hip Score ◽  
Porous Tantalum ◽  
Imaging Results ◽  
Harris Score

Abstract Background To evaluate the survival rate of porous tantalum rod implantation in the treatment of avascular necrosis of the femoral head, to evaluate its clinical effect and imaging results, and to analyze the reasons for its failure to return to total hip arthroplasty (THA). Methods From January 2008 to December 2013, tantalum rod implantation for avascular necrosis of the femoral head was performed in two institutions. Statistical analysis of operation data, including operation time, blood loss and blood transfusion. Harris hip score and imaging results were evaluated. Kaplan Meier survival analysis was performed with THA as the end point. Histopathological observations were performed on femoral head specimens with the tantalum rods that failed THA after tantalum rod implantation. Results 42 patients (52 hips) were followed up completely, the average follow-up time was 74.3 months (60-120 months). 24 hips turned to THA at the end of follow-up (46.2%), the average time was (44 ± 32) months, and the average Harris score before THA was (57 ± 10). The follow-up time of 28 patients without THA was 78.6 ± 13.8 months, and the average Harris score was 80.6 ± 2.8. Histopathological examination revealed the implant surface is in contact with sparse Island bone. There is limited bone tissue extending inward from the implant. In the living bone area, there was “on-growth” of new bone but no “in-growth”. In the necrotic area, there was no obvious new bone regeneration. Conclusion The mid-and-long term clinical effect of tantalum rod implantation in the treatment of avascular necrosis of the femoral head is not good, and the osteogenic activity of tantalum rod in the femoral head is limited. ARCO stage, age and bone marrow edema were risk factors for the failure of tantalum rod implantation to THA.

scholarly journals Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 3-12
Author(s):  
Martina Rocchi ◽  
Nicoladrea Del Piccolo ◽  
Alessandro Mazzotta ◽  
Gianluca Giavaresi ◽  
Milena Fini ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Platelet Rich Plasma ◽  
Core Decompression ◽  
Joint Surface ◽  
Harris Hip Score ◽  
Functional Scores

Introduction: Avascular necrosis of femoral head (AVN) is 1 of the main factors causing disability in young adults. Hip prosthesis can be considered an effective treatment of the painful symptoms but it is a major surgical intervention for this type of population. Thus, a large space should be left to therapeutic alternatives such as regenerative medicine. This retrospective study evaluates 52 AVN treated by core decompression, bone chips allograft, fibrin platelet-rich plasma (PRF) and concentrated autologous mesenchymal stromal cells (MSCs). Methods: The AVN was diagnosed using magnetic resonance imaging (MRI) and graded according to ARCO classification: a patient was classified stage 1 (21 patients), stage 3 (26 patients), and 4 patients were classified as stage 4. We evaluated patients with functional scores (Harris Hip Score) and radiological analysis at 3, 6, 12 and 24 months after the procedure. Patients requiring prosthetic replacement of the joint were included; in these cases, follow-up was interrupted at the time of the joint replacement procedure. Results: Our statistical analysis showed differences between survived and failed treatments, in terms of patient profile and ARCO radiological classification. The best result occurred in patients with ARCO grades 1 and 2, while the more advanced grades showed a high failure rate. It is interesting to note that ARCO quantification, conceived as the joint surface involved in the necrosis, has a negative influence on the outcome of the procedure. Indeed, patients affected by ARCO 3a, where necrosis involved a small portion of the femoral epiphysis and the collapse of the articular surface was limited to 2 mm, showed results similar to those obtained in patients with ARCO 1 and 2. Conclusions: In conclusion, compared with the alternative technique of decompression, our data suggest that post-collapse cases with a small area of necrosis and the use of bone grafts may show better results compared to those of the literature.

Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up

2019 ◽  
Vol 101-B (4) ◽  
pp. 403-414 ◽  
Author(s):  
T. D. Lerch ◽  
S. Vuilleumier ◽  
F. Schmaranzer ◽  
K. Ziebarth ◽  
S. D. Steppacher ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Slipped Capital Femoral Epiphysis ◽  
Harris Hip Score ◽  
Slip Angle ◽  
Functional Scores ◽  
Screw Breakage ◽  
Long Term Follow Up

AimsThe modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE.Patients and MethodsWe performed a retrospective analysis involving 46 hips in 46 patients treated with a modified Dunn procedure for severe SCFE (slip angle > 60°) between 1999 and 2016. At nine-year-follow-up, 40 hips were available for clinical and radiological examination. Mean preoperative age was 13 years, and 14 hips (30%) presented with unstable slips. Mean preoperative slip angle was 64°. Kaplan–Meier survivorship was calculated.ResultsAt the latest follow-up, the mean Merle d’Aubigné and Postel score was 17 points (14 to 18), mean modified Harris Hip Score was 94 points (66 to 100), and mean Hip Disability and Osteoarthritis Outcome Score was 91 points (67 to 100). Postoperative slip angle was 7° (1° to 16°). One hip (2%) had progression of osteoarthritis (OA). Two hips (5%) developed AVN of the femoral head and required further surgery. Three other hips (7%) underwent implant revision due to screw breakage or change of wires. Cumulative survivorship was 86% at ten-year follow-up.ConclusionThe modified Dunn procedure for severe SCFE resulted in a low rate of AVN, low risk of progression to OA, and high functional scores at long-term follow-up. The slip deformities were mainly corrected but secondary impingement deformities can develop in some hips and may require further surgical treatment. Cite this article: Bone Joint J 2019;101-B:403–414.

scholarly journals A Functional and Radiological Outcome Analysis of Hip Forage Procedure, done for Early Stages(Ficat and Arlet Grade 1 and 2A) of Avascular Necrosis of Head of Femur

2021 ◽  
pp. 97-105
Author(s):  
Shubham Padmawar ◽  
Dr. Suhas Landge ◽  
Prateek Upadhyay ◽  
Mitali Madhusmita
Keyword(s):  
Femoral Head ◽  
Disease Progression ◽  
Avascular Necrosis ◽  
Core Decompression ◽  
Foot Drop ◽  
Harris Hip Score ◽  
Moderate Pain ◽  
Radiological Outcome ◽  
Mild Pain

Background: Avascular necrosis of the femoral head is a severe disease and causes osteoarthritis of the hip joint in young adults. Early diagnosis leads to better prognosis and therapeutic success. Aim: To study pain, radiological outcome & functional outcome post hip forage procedure in patients of avascular necrosis of head of femur (Ficat and Arlet grade 1 and grade 2A). Study Design: This was a prospective observational study. Place and Duration of Study: Conducted in the Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai over a period of 2 years from 2015 to 2017 Methodology: We included 50 patients (39 males, 11 females) with Avascular necrosis of unilateral or bilateral head of femur (Grade 1 and Grade 2A), clinical, radiological and functional(with the help of Harris hip score) examination was done at 6 months and 12 months follow up post operatively.  Results: Out of the 50 patients, pre-peratively, 60% reported moderate pain, 20% mild pain and 20% severe pain. At follow-up, 36% patients reported slight pain, 26% mild pain, 26% moderate pain, 8% marked pain, and no pain was reported by 4% patients. Pre-operatively, no limp was seen in 34% patients, while 66% patient had a limp. At follow-up, 70% patient had a limp and no limp in 30% patients. Before surgery, support (cane use) was required by 6% patients, while at follow-up, support was noted by 12% patients. Preoperative mean Harris Hip Score was 63.6, while that at follow-up it was 74.74. Radiological worsening of the disease occurred only in 38% of the patients which suggests that disease progression was delayed in most patients(62%). 2% patients had a complication of foot drop. Conclusion: Avascular necrosis of femoral head is more common in young males. Core decompression by multiple drilling and/or core decompression with fibular strut grafting are equally effective in pre collapse stages (stage 1 and stage 2A) with better functional and radiological outcomes and hence these procedures can play a vital role in delaying the disease progression.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

Avascular necrosis of the femoral head: Evaluation of hyperbaric oxygen therapy and quality of life

2020 ◽  
pp. 561-569
Author(s):  
Angeliki Chandrinou ◽  
◽  
Anna Korompeli ◽  
Eirini Grammatopoulou ◽  
Konstantina Gaitanou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Harris Hip Score ◽  
Controlled Study ◽  
Second Phase

Introduction: The treatment of avascular necrosis of the femoral head (AVNFH) is based on invasive (e.g., core decompression) and non-invasive methods (e.g., hyperbaric oxygen therapy – HBO2). The purpose of the present study is to evaluate the effect of HBO2 on the quality of life (QoL) of patients with AVNFH. Methods: This was a prospective observational non-controlled study of patients with AVNFH treated by HBO2. It was conducted, with the use of Steinberg scale, on 73 patients with AVNFH Stage I or II who were treated with HBO2. Patients’ QoL was assessed with EuroQol-5D-5L (EQ), Harris Hip Score (mHHS), MAHORN (MHOT), and VAS, in three different phases: before HBO2; after the completion of the first phase (20 HBO2 sessions, up to two months); and after the completion of the second phase (20 HBO2 sessions, up to two months after the first phase). A reassessment was made on the completion of each phase. Ratings were also made after the completion of each phase, over the first five months of follow-up. Results: All 73 patients (67.1% males, 32.9% females, mean age: 40.34, SD ± 9.99) participated in the study. Steinberg scale, mean EQ (F (1, 57) = 25.18, η2 = .306 and F (1, 43) = 43.402, η2 = .502); mHHS (F (1, 61) = 67.13, η2 = .524) and F (1, 43) = 31.84, η2 = .425); MHOT (F (1, 61) = 11.68, η2 = .161) and F (1, 43) = 98.01, η2 = .695); and VAS (F (1, 53) = 24.11, η2 = .313) and F (1, 39) = 45.61, η2 = .539), improved between the first and second measurements and between the second and third measurement accordingly (p < .01). Conclusions: HBO2 treatment does not induce alteration of quality of life and is well tolerated and accepted by patients.

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