scholarly journals Micro-core decompression combined with intralesional zoledronic acid as a treatment of osteonecrosis of femoral head: a novel technique

2020 ◽  
Vol 6 (5) ◽  
pp. 914
Author(s):  
Muhammed Ashraf ◽  
Jyothis George ◽  
Ibad Sha I.
Keyword(s):  
Zoledronic Acid ◽  
Femoral Head ◽  
Core Decompression ◽  
Stage I ◽  
Stage Iii ◽  
Harris Hip Score ◽  
Total Hip ◽  
Novel Technique ◽  
The Mean ◽  
Modified Harris Hip Score

<p class="abstract"><strong>Background:</strong> Avascular necrosis (AVN)/osteonecrosis of the femoral head is a debilitating condition affecting the hip joint and is one of the most common causes of total hip replacement. The available treatments include pharmacological and surgical options with total hip arthroplasty (THA) being the mainstay of treatment. This present study is a novel technique of combining micro core decompression with intra-lesional bisphosphonate as a treatment for osteonecrosis of the hip.</p><p class="abstract"><strong>Methods:</strong> A prospective study of 19 hips was done. There were 11 males and 4 females ranging 42-63 years. Four hips were stage I, ten hips were stage IIA, three hips were stage IIb and two hips were stage III.  16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The minimum period of follow up was 24 months. All patients were assessed according to the Harris hip score. The operative procedure includes decompressing the avascular area with drilling then injecting the zoledronic acid locally.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean preoperative modified Harris hip score in stage I (n=4), stage IIa (n=10), stage IIb (n=3) and stage III (n=2) were 81.9, 72.7, 68.8 and 59.2 respectively. The mean postoperative modified Harris hip score at two years in stage I, stage IIa, stage IIb and stage III were 97.3, 91.1, 88.4 and 82.5 respectively.</p><p class="abstract"><strong>Conclusions:</strong> We found that the use of micro core-decompression with intra-lesional bisphosphonate will provide higher chances towards hip preservation especially in late cases or cases with larger lesions where core decompression may not be successful.</p><p class="abstract"> </p>

scholarly journals Is large femoral head a better option than a conventional femoral head primary total hip arthroplasty in Indian population

2021 ◽  
Vol 7 (2) ◽  
pp. 295
Author(s):  
Hiranya Kumar Seenappa ◽  
Karthik Mittemari Naraynamurthy ◽  
Rasiq Rashid ◽  
Shivraj Nadagouda ◽  
Vamshhikrishna Chand
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Age Group ◽  
Neck Of Femur ◽  
Large Femoral Head ◽  
Total Hip ◽  
Modified Harris Hip Score ◽  
Primary Total Hip Arthroplasty

<p class="abstract"><strong>Background: </strong>Study aimed to assess and compare the functional outcome in patients underwent the large femoral head THA and conventional femoral head THA.</p><p class="abstract"><strong>Methods:</strong> It is a comparative prospective cross sectional study conducted among the patients undergoing primary total hip arthroplasty through postero-lateral approach at department of orthopaedics Vydehi institute of medical sciences, Bengaluru during the period of July 2017 to July 2019. Patients aged between 18-80years of both genders undergoing Primary THA for Osteoarthritis (OA), Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Post traumatic arthritis, Avascular necrosis (AVN), Acute fracture neck of femur, Non-union fracture neck of femur (NOF). Patients undergoing primary total hip arthroplasty in Intertrochanteric fracture, Acetabular fracture and patients undergoing Revision Hip Arthroplasty were excluded from study. Patients were grouped as the ones treated with large femoral head THA and conventional femoral head THA.</p><p class="abstract"><strong>Results: </strong>This series consisted of 36 patients with 44 diseased hips treated with primary total hip arthroplasty (THA). Out of 36 patients, 9 patients (25%) belonged to an age group of below 30 years of age, 10 patients (27.8%) belonged to the age group between 31-40 years of age, 8 patients (22.2%) belonged to the age group 41-51 years of age and 9 patients (25%) belonged to age group of 51-60 years of age. The mean level of Modified Harris Hip score and improvement of movements in all planes was found to be statistically significantly in the patients treated with large femoral head primary THA compared to those treated with conventional method. (p&lt;0.001)</p><p class="abstract"><strong>Conclusions: </strong>Study has shown improved functional outcome (Modified harris hip score) and range of movement in the patients treated with the large femoral head primary THA as compared to those treated with a conventional femoral head.</p>

A MODIFIED DECOMPRESSION AND BONE GRAFT TECHNIQUE FOR THE TREATMENT OF AVASCULAR NECROSIS OF THE FEMORAL HEAD

2016 ◽  
Vol 19 (01) ◽  
pp. 1650005
Author(s):  
Ahmad M. Shehadeh ◽  
Samer Abed El Al ◽  
Ahmad Ja’far ◽  
Ahmad Salem ◽  
Imad Abo Shahin ◽  
...  
Keyword(s):  
Pain Relief ◽  
Femoral Head ◽  
Bone Graft ◽  
Avascular Necrosis ◽  
Core Decompression ◽  
Stage I ◽  
Harris Hip Score ◽  
Graft Material ◽  
Modified Technique ◽  
Average Operative Time

Objectives: Avascular necrosis (AVN) of the femoral head is a pathologic process resulting from interruption of blood supply to bone. The aim of this paper is to describe the technical aspects and outcome of a modified technique of core decompression and bone graft injection for the treatment of AVNFH. Methods: A total of 20 patients (26 femoral head AVN) Ficat stage I to early III were treated using core decompression kit followed by injection with bone graft material. Nine hips were stage III, 16 stage II and 1 stage I. Average operative time was 25[Formula: see text]min. Results: At a median follow-up of 48 months, 20 hips (77%) had almost complete pain relief while pain persisted in 6 hips (23%). All patients who demonstrated clinical response exhibited radiological stabilization of disease. The mean Harris hip score for all patients’ prior and following surgery were 41 and 85, respectively ([Formula: see text]). Conclusions: Femur head decompression using core decompression kit followed by bone substitute injection can result in long-term pain relief and prevent progression of AVN in the majority of patients.

Combination of hyperbaric oxygen and core decompression therapies improve outcomes in the treatment of hip osteonecrosis

2021 ◽  
pp. 112070002110032
Author(s):  
Ibrahim Bozkurt ◽  
Nadir Yalcin ◽  
Enes Uluyardimci ◽  
Esra Artvinli Akgul
Keyword(s):  
Femoral Head ◽  
Hyperbaric Oxygen ◽  
Combined Treatment ◽  
Core Decompression ◽  
Stage Ii ◽  
Harris Hip Score ◽  
Combination Group ◽  
Sf 36 ◽  
Functional Scores ◽  
The Mean

Introduction: To investigate whether combined treatment of hyperbaric oxygen (HBO) and core decompression (CD) result with better outcomes and have an additional influence on health quality scores when compared with HBO alone. Methods: 63 consecutive patients’ 80 hips (43 male, 20 female, 17 bilateral), diagnosed with Stage II Osteonecrosis of the femoral head were included in our study. The mean age at presentation in the HBO and CD + HBO groups were 39.9 years and 39.2 years, respectively. The mean follow-up was 39.8 months (24–56 months) for HBO group and 43.1 months (24–58 months) for the CD + HBO group. Standard radiographs and MRI were performed initially and during controls. Clinical outcomes were assessed using the modified Harris Hip Score (HHS), the visual analogue score (VAS) and SF-36 life quality score. Results: 52 hips (65%) were Ficat Stage IIa and 28 hips (35%) were IIb. Totally, 46 hips (30 hips IIa, 16 hips IIb) were in HBO alone group and 34 hips (22 hips IIa, 12 hips IIb) were in CD + HBO group. Both VAS and HHSs were improved in each group after treatment ( p < 0.001). When both groups were compared, this improvement was more distinct and evident in CD + HBO combination group than HBO alone group ( p < 0.001). The physical function and pain components of SF-36 survey were found to be different in between two groups ( p < 0.005). Discussion: HBO treatment decreases pain, increases functional scores for Ficat Stage II patients. Addition of HBO treatment to decompression of the femoral head improves the results better than HBO alone. In particular, reduction of pain is more prevalent for Stage IIa patients than IIb with combination of HBO and CD therapies.

scholarly journals Short Term Clinical Outcome of a Porous Tantalum Implant for the Treatment of Advanced Osteonecrosis of the Femoral Head

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Melissa Nadeau ◽  
Chantal Séguin ◽  
John S Theodoropoulos ◽  
Edward J Harvey
Keyword(s):  
Femoral Head ◽  
Clinical Outcome ◽  
Success Rate ◽  
Donor Site ◽  
Core Decompression ◽  
Treatment Modalities ◽  
Harris Hip Score ◽  
Porous Tantalum ◽  
The Mean ◽  
Mean Time

Purpose of the study: Osteonecrosis of the hip mostly affects young individuals and oftenprogresses to a debilitating disease. Several treatment modalities exist, but none are completely satisfactory. This study evaluates the clinical outcome of patients treated with core decompression and insertion of a porous tantalum implant in the femoral head. This procedure is similar to commonly performed procedures, but has the additional advantages of providing structural support to the necrotic femoral head while having no donor-site morbidity. Methods: We evaluated 15 patients with 18 osteonecrotic hips with Steinberg stage III (3 hips) and IV (15 hips) disease. The mean age of the patients was 42 years-old (eldest 66), and the mean time for follow-up was 23 months. The outcome measure was hip function, evaluated with the Harris hip score, and the end point was total hip arthroplasty, or referral for this procedure. Results: The success rate at twelve months postoperatively was 77.8%, and the overall success rate was 44.5%. Failures occurred at a mean time of 11.7 months, and one complication, a periprosthetic fracture, occurred 4 months postoperatively. On average, patients who did well improved their Harris hip scores by 21.7 points, and patients who eventually required arthroplasty decreased their scores by 14 points. Conlusions: Core decompression with porous tantalum implants showed encouraging success rates and early clinical results in patients with advanced stage osteonecrosis, but further larger scale studies are required to identify the population best suited for this procedure.

scholarly journals EVALUATION OF THE RESULTS OF CEMENTLESS TOTAL HIP ARTHROPLASTY IN PATIENTS WITH STAGES IV, V AND VI OSTEONECROSIS OF THE FEMORAL HEAD

2020 ◽  
Vol 62 (1) ◽  
Author(s):  
Đắc Việt Mai ◽  
Thu Thủy Nguyễn
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Ingrowth ◽  
Femoral Stem ◽  
Stage Iv ◽  
Harris Hip Score ◽  
Total Hip ◽  
The Mean

This study aimed to report the outcome of total hip arthroplasty (THA) with an extensive hydroxyapatite (HA) coating for the fixation of a tapered femoral stem (Corail) in patients aged 60 or younger than sixty years with stage IV, V và VI osteonecrosis of femoral head. Subject and method: Descriptive prospective research of ninety osteonecrotic hips in ninety patients were available for clinical and radiographic analyses at minimum follow-up of 5 years. Results and Conclusion: The mean Harris hip score improved from 43.74 ± 9,25points preoperatively to 96.67 ± 3.82points at final follow-up. Seventy-four (100%) hips demonstrated stable bone ingrowth. No hips showed acetabular or femoral osteolysis radiolucency and loosening, or required revision for aseptic loosening. We believe that cementless THA with a Corail stem is a promising procedure for patients with osteonecrosis of the femoral head.

scholarly journals Management and Outcome of Patients With Femoral Head Fractures: Injuries and Associated Prognostic Factors

2021 ◽  
Author(s):  
Sujan Shakya ◽  
Jialei Chen ◽  
JiaChen Sun ◽  
Zhou Xiang
Keyword(s):  
Femoral Head ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Functional Outcomes ◽  
Fixation Method ◽  
Harris Hip Score ◽  
Femoral Head Fracture ◽  
Total Hip ◽  
Surgical Methods ◽  
Modified Harris Hip Score

Abstract Objective: Femoral head fractures are rare injuries that are often associated with poor functional outcome and complications. Fracture management and surgical methods for these fractures are variable. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications and functional outcomes of femoral head fractures.Methods: We conducted a retrospective review of fifty patients who sustained femoral head fractures from January 2011- December 2018. There were thirty-seven males and thirteen females with median age of 40 years. A surgical approach and fixation method were recorded. Patients were classified according to the Pipkin Classification system. Clinical results were evaluated for patients with two years or greater follow-up using the Modified Harris Hip Score (MHHS). Results: Eight patients (16%) were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, 5 (10%) patients required immediate Total Hip Replacement (THR). Six (12%) developed AVN, four (8%) requiring secondary total hip replacement (THR). Sixteen patients (33%) developed PTA, eight (16%) developed HO and six patients (12 %) had sciatic nerve injury, none requiring operative treatment. Overall functional results, according to modified Harris hip score were excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. Conclusion: Femoral head fracture are a rare injury that are often associated with poor outcome. In this study we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on Pipkin classification. This study, adds to the growing literature on femoral head fractures and provide reference for the clinical treatment to guide patient management.

Inverted Femoral Head Graft versus Standard Core Decompression in Nontraumatic Hip Osteonecrosis at Minimum 3 Years Follow-up

2017 ◽  
Vol 27 (1) ◽  
pp. 74-81 ◽  
Author(s):  
Asser A. Sallam ◽  
Mohamed A. Imam ◽  
Khaled S. Salama ◽  
Osman A. Mohamed
Keyword(s):  
Femoral Head ◽  
Core Decompression ◽  
Harris Hip Score ◽  
Obese Patients ◽  
Case Review ◽  
Survivorship Analysis ◽  
Hip Osteonecrosis ◽  
Kaplan Meier ◽  
Modified Harris Hip Score

Purpose Numerous salvage surgeries were popularised to halt the progression of hip osteonecrosis (ON). We aimed to compare the clinico-radiological outcomes of inverted femoral head graft (IFHG) versus standard core decompression (SCD) in treatment of nontraumatic hip ON at pre-arthritic stage. Methods A case review was performed at a minimum 3 years follow-up of 61 patients (71 hips; mean age 32.96 (19-50) years; mean follow-up 7.86 (3-14) years; mean body mass index 28.58 (19-46); 32 males, 29 females) suffering nontraumatic hip ON at pre-arthritic stage. 38 hips underwent SCD and 33 IFHG. The outcome was assessed by changes in modified Harris Hip Score (MHHS), need for revision surgery and progression of modified Ficat-Arlet staging. Data were analysed including logistic regression and Kaplan-Meier survivorship analysis. Results 13/34 (38.2%) hips in SCD group were revised at 4.61 ± 2.61 years, while 7/33 (21.2%) in IFHG group at 8.43 ± 4.32 years (p = 0.023). MHHS was significantly higher in IFHG group at 1 and 3 years as well as at last follow-up (p = 0.014, 0.001 and 0.023 respectively). Clinical and radiological significant differences were found in survivorship analysis between both groups, in favor of IFHG. A higher clinical failure was noted among obese patients. Conclusions An IFHG technique offers a better alternative regarding postoperative clinico-radiological outcomes in nontraumatic hip ON at the pre-arthritic stage. A cautious prognosis is recommended in obese patients.

Management of Early Avascular necrosis of femoral head with Core Decompression and Platelet Rich Plasma infiltration

2021 ◽  
Vol 12 (4) ◽  
pp. 2434-2440
Author(s):  
Aditya Pundkar ◽  
Sandeep Shrivastav ◽  
Swapnil Date
Keyword(s):  
Femoral Head ◽  
Bone Grafting ◽  
Platelet Rich Plasma ◽  
Weight Bearing ◽  
Core Decompression ◽  
Good Alternative ◽  
Harris Hip Score ◽  
Pharmacological Agents ◽  
Replacement Surgery ◽  
The Mean

Various modalities available for the treatment of AVN range from conservative modalities like observation and non-weight-bearing mobilization, various pharmacological agents like Bisphosphonates, Enoxaparin are shown to be useful in some studies, Hyperbaric oxygen therapy to Surgical modalities like femoral head preserving procedures (core decompression with or without additional procedure, i.e. bone grafting, biologic adjuvants – Platelet Rich Plasma, Stem cells etc. and rotational osteotomies) and replacement surgeries. 20 patients of Early AVN who met inclusion criteria and operated with core decompression and PRP infiltration were included in this study. Out of 20 patients, 2 patients (10%) had superficial infections which healed on its own without any intervention, 5 patients (25%) had restriction of movements and 3 patients (15%) required replacement surgery. The mean pre-operative Harris Hip Score of our study was 64.3, and the mean post-operative Harris hip score of our study was 80.2. Out of 20 cases, 6 patients (30%) showed limitation of the progression of the disease, 3 (15%) patients progressed to the further stages of the disease and 11 patients (55%) had remission of the disease. The final outcome, on the basis of Harris Hip Score in 5 patients (25%), was excellent, 7 patients (35%) was good, 5 patients (25%) was fair, and in 3 patients (15%) was poor. Our study concludes that Core decompression along with PRP infiltration can be used as a good alternative for or in addition with traditionally performed core decompression and bone grafting. 

scholarly journals The Outcome of Treatment of Femural Head Fracture: A Single-Center Retrospective Study

2020 ◽  
Vol 7 (3) ◽  
pp. 105-114
Author(s):  
Ali Yeganeh ◽  
◽  
Hossein Farahini ◽  
Mikaiel Hajializade ◽  
Shadi Abdollahi Kordkandi ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Type I ◽  
Associated Injuries ◽  
Total Hip ◽  
Best Management ◽  
Therapeutic Algorithm ◽  
The Mean

Background: There is no concrete information about many aspects of femoral fracture, including its best management. We hypothesized that reporting the outcomes of patients managed with the same therapeutic algorithm would help the selection of best management strategies.  Objectives: In this study, we report the outcomes and complications of femoral head fracture in patients treated according to our therapeutic algorithm. Methods: In a retrospective review of a prospectively collected orthopedic database, 41 patients with femoral head fractures were evaluated. Fractures were classified by the Pipkin classification system. The clinical outcome was assessed with the Harris Hip Score (HHS). In brief, our therapeutic algorithm included conservative treatment for the congruous joint of Pipkin type I and II, total hip arthroplasty for unfixable fractures of Pipkin type III, and IV, and fixation via three approaches otherwise (Smith-Peterson, Kocher, or surgical dislocation). Results: Of 41 cases, 34 cases (82.9%) had uncomplicated outcomes. The number of associated injuries was significantly more in patients with complicated outcomes (P=0.049). Avascular necrosis was the most common complication (n=5, 12.2%). Their Mean±SD HHS was 85.1±109. Accordingly, HHS scoring had poor, fair, good and excellent results in 4 (9.8%), 6 (14.6%), 13 (31.7%), and 17 (41.5%) patients, respectively. The mean HHS score was significantly lower in patients with complicated outcomes (P=0.007). The mean HHS score was not associated with types of fracture (P=0.071).   Conclusion: The outcome of femoral head treatment was good to excellent in the majority of patients. However, patients who underwent total hip arthroplasty or had associated injuries are at higher risk of an inferior outcome. 

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