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

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.

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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

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

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201118133-37 ◽

2011 ◽

Vol 18 (1) ◽

pp. 33-37

Author(s):

Il'dar Fuatovich Akhtyamov ◽

O G Anisimov ◽

Yu V Budyak ◽

A N Kovalenko ◽

A S Korotkova ◽

...

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Conservative Treatment ◽

Preliminary Report ◽

Pain Syndrome ◽

Course Completion ◽

New Method ◽

Functional Abilities ◽

Joint Region ◽

Aseptic Necrosis

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.

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Nonpsychotic mental disorders in patients with aseptic necrosis of the femoral head (literature review)

Ukrains'kyi Visnyk Psykhonevrolohii ◽

10.36927/2079-0325-v29-is2-2021-11 ◽

2021 ◽

pp. 63-67

Author(s):

Viktoriia Ogorenko ◽

Andrii Shornikov

Keyword(s):

Quality Of Life ◽

Femoral Head ◽

Mental Disorders ◽

Recovery Period ◽

Joint Damage ◽

Nerve Fibers ◽

Chinese Patients ◽

Anxiety And Depression ◽

Aseptic Necrosis

Recently it has been reported of significant progress in the providing of surgical care to patients with aseptic necrosis of the femoral head. Given the unity of mental and somatic factors, as well as data on the interaction of mental factors and other chronic diseases of the hip joint, there is a significant link between non-psychotic mental disorders and aseptic necrosis of the femoral head. The aim of this review was to present current data on psychiatric disorders in patients of this category. Prolonged stress exposure, in particular due to pain, with activation of the sympathoadrenal system on the one hand and maintaining a high level of anxiety due to neurotic mechanisms of psychological protection on the other hand can lead to joint damage due to reduced sympathetic nerve fibers. Available data for incidence of anxiety and depression in Chinese patients show that almost every fifth patient has clinically significant symptoms. The stage of the disease (the need for surgical treatment) and comorbid diseases significantly increase the risk of anxiety and depression. Considerable attention is paid to the patient’s alcohol consumption problems and the relationship between alcohol abuse and the occurrence of aseptic necrosis. The presence of restrictions in movements influent not only to the physical, but also to the mental components of the quality of life. Physical and mental discomfort, pain, low quality of life are factors that reduce the willingness to participate in preventive measures, which ultimately leads to the need for more radical surgical intervention. Evaluation by a mental health professional before hip surgery allows for better results in the delayed recovery period.

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Experience of conservative treatment of genital prolapse with urogynecological pessaries

GYNECOLOGY ◽

10.26442/20795696.2019.1.190228 ◽

2019 ◽

Vol 21 (4) ◽

pp. 24-26

Author(s):

Gennady Y Yarin ◽

Inna A Vilgelmi ◽

Evgeny V Liuft

Keyword(s):

Patient Satisfaction ◽

Pelvic Organ Prolapse ◽

Conservative Treatment ◽

Genital Prolapse ◽

Treatment Method ◽

Pelvic Organ ◽

Safety And Efficacy ◽

Treatment Methods ◽

Complications Rate

Background. Pelvic organ prolapse is one of the most common women's diseases worldwide. Genital prolapse incidence among women over 50 is on average 41%. There are variety methods for genital prolapse treatment; they are divided into surgical and non-surgical ones. One of the conservative treatment methods is a use of pessaries. According to different studies an efficacy of pessary therapy is approximately 60%. Aim to estimate a safety and efficacy of genital prolapse conservative treatment with a cube pessary on the basis on standardized questionnaires. Outcomes and methods. In ANO “NRITO Clinic” Urology and Gynecology Center 26 women with various degree genital prolapse were treated with pessary within the period from August 2015 to March 2016. Efficacy of pessaries use, patient satisfaction with this treatment method and complications rate were estimated. Results. Urogynecological cube pessary use in a treatment of various types of genital prolapse is quite an effective method (p

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Possibilities of conservative treatment methods in restoration of visual functions in acquired myopia

Practical medicine ◽

10.32000/2072-1757-2019-1-49-51 ◽

2019 ◽

Vol 17 (1) ◽

pp. 49-51

Author(s):

A. E. Aprelev ◽

◽

N. P. Setko ◽

A. M. Iserkepova ◽

◽

...

Keyword(s):

Conservative Treatment ◽

Treatment Methods ◽

Visual Functions

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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.

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Outcome after a new porous tantalum rod implantation for treatment of early-stage femoral head osteonecrosis

Annals of Translational Medicine ◽

10.21037/atm.2019.08.86 ◽

2019 ◽

Vol 7 (18) ◽

pp. 441-441 ◽

Cited By ~ 1

Author(s):

Wei Huang ◽

Xuan Gong ◽

Steve Sandiford ◽

Xiaoqiang He ◽

Feilong Li ◽

...

Keyword(s):

Femoral Head ◽

Early Stage ◽

Porous Tantalum ◽

Femoral Head Osteonecrosis

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Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

Foot & Ankle International ◽

10.1177/10711007211002826 ◽

2021 ◽

pp. 107110072110028

Author(s):

Thos Harnroongroj ◽

Theerawoot Tharmviboonsri ◽

Bavornrit Chuckpaiwong

Keyword(s):

Regression Analysis ◽

Conservative Treatment ◽

Demographic Characteristics ◽

Classification Systems ◽

Clinical Severity ◽

P Value ◽

Level Of Evidence ◽

Factors Associated ◽

Radiographic Parameters ◽

Significant Difference

Background: Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between “successful” and “failure” conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment. Methods: We retrospectively reviewed 68 patients with MWD divided into 29 “failure” and 39 “successful” conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A P value <.05 was considered a statistically significant difference. Results: We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group ( P < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment. Conclusion: Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors. Level of evidence: Level III, retrospective comparative study.

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Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

Foot & Ankle International ◽

10.1177/1071100719883266 ◽

2019 ◽

Vol 41 (2) ◽

pp. 187-192

Author(s):

Ricardo E. Colberg ◽

Monte Ketchum ◽

Avani Javer ◽

Monika Drogosz ◽

Melissa Gomez ◽

...

Keyword(s):

Conservative Treatment ◽

Plantar Fasciitis ◽

Case Series ◽

Successful Outcome ◽

Oral Steroid ◽

Tarsal Tunnel ◽

Retrospective Case ◽

Level Of Evidence ◽

Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

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