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

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 The efficacy and safety of core decompression for the treatment of femoral head necrosis: a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Kun-chi Hua ◽  
Xiong-gang Yang ◽  
Jiang-tao Feng ◽  
Feng Wang ◽  
Li Yang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Femoral Head ◽  
Radiographic Progression ◽  
Meta Analysis ◽  
Core Decompression ◽  
Femoral Head Necrosis ◽  
Significant Difference ◽  
Autologous Bone ◽  
Necrosis Of Femoral Head ◽  
Rate Of Success

Abstract Background Core decompression (CD) is an important method for the treatment of osteonecrosis of the femoral head (ONFH). Few articles investigate the influence of core decompression on outcomes of ONFH. This study was carried out to observe the safety and effectiveness of core decompression in the treatment of ONFH. Methods A comprehensive literature search of databases including PubMed, Embase, and Cochrane Library was performed to collect the related studies. The medical subject headings used were “femur head necrosis” and “Core decompression.” The relevant words in title or abstract included but not limited to “Osteonecrosis of the Femoral Head,” “femoral head necrosis,” “avascular necrosis of femoral head,” and “ischemic necrosis of femoral head.” The methodological index for nonrandomized studies was adopted for assessing the studies included in this review. Results Thirty-two studies included 1865 patients (2441 hips). Twenty-one studies (1301 hips) using Ficat staging standard, 7 studies (338hips) using Association Research Circulation Osseous (ARCO) staging standard, and University of Pennsylvania system for staging avascular necrosis (UPSS) staging criteria for 4 studies (802 hips). All the studies recorded the treatment, 22 studies (1379 hips) were treated with core decompression (CD) alone, and 7 studies (565 hips) were treated with core decompression combined with autologous bone (CD Autologous bone). Nine subjects (497 hips) were treated with core decompression combined with autologous bone marrow (CD Marrow). Twenty-seven studies (2120 hips) documented the number of conversion to total hip replacement (THA), and 26 studies (1752hips) documented the number of radiographic progression (RP). Twenty-one studies recorded the types of complications and the number of cases, a total of 69 cases. The random-effect model was used for meta-analysis, and the results showed that the overall success rate was 65%. The rate of success showed significant difference on the outcomes of different stages. The rate of success, conversion to THA, and radiographic progression showed significant difference on the outcomes of ONFH using different treatments. Conclusions Core decompression is an effective and safe method of treating ONFH. The combined use of autologous bone or bone marrow can increase the success rate. For advanced femoral head necrosis, the use of CD should be cautious. High-quality randomized controlled trials and prospective studies will be necessary to clarify the effects of different etiology factors, treatments, and postoperative rehabilitation. Until then, the surgeon can choose core decompression to treat ONFH depending on the patient’s condition. Level of evidence I Meta-analysis

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 Osteonecrosis Intervention Rod Versus Core Decompression Using Multiple Small Drill Holes on Early Stages of Necrosis of the Femoral Head: A Prospective Study on a Series of 60 Patients with a Minimum 1-Year-Follow-Up

2015 ◽  
Vol 9 (1) ◽  
pp. 179-184 ◽  
Author(s):  
Haixiong Miao ◽  
Dongping Ye ◽  
Weiguo Liang ◽  
Yicun Yao
Keyword(s):  
Femoral Head ◽  
Core Decompression ◽  
Alternative Methods ◽  
Early Stages ◽  
Significant Difference ◽  
Harris Score ◽  
The Mean ◽  
Drill Holes ◽  
Partial Weight

Introduction: The conventional CD used 10 mm drill holes associated with a lack of structural support. Thus, alternative methods such as a tantalum implant, small drill holes, and biological treatment were developed to prevent deterioration of the joint. The treatment of CD by multiple 3.2 mm drill holes could reduce the femoral neck fracture and partial weight bearing was allowed. This study was aimed to evaluate the effect of osteonecrosis intervention rod versus core decompression using multiple small drill holes on early stages of necrosis of the femoral head. Method: From January 2011 to January 2012, 60 patients undergoing surgery for osteonecrosis with core decompression were randomly assigned into 2 groups based on the type of core decompression used: (1) a total of 30 osteonecrosis patients (with 16 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with a porous tantalum rod insertion. The diameter of the drill hole for the intervention rod was 10mm.(2) a total of 30 osteonecrosis patients (with 14 hips on Steinburg stageⅠ,20 hips on Steinburg stageⅡ) were treated with core decompression using five drill holes on the lateral femur, the diameter of the hole was 3.2 mm. The average age of the patient was 32.6 years (20-45 years) and the average time of follow-up was 25.6 months (12- 28 months) in the rod implanted group. The average age of the patient was 35.2 years (22- 43 years) and the average time of follow-up was 26.3 months (12-28 months) in the small drill holes group. Results: The average of surgical time was 40 min, and the mean volume of blood loss was 30 ml in both surgical groups. The average of Harris score was improved from 56.2 ± 7.1 preoperative to 80.2 ± 11.4 at the last follow-up in the rod implanted group (p < 0.05). The mean Harris score was improved from 53.8 ± 6.6 preoperative to 79.7 ± 13.2 at the last follow-up in the small drill holes group (p<0. 05). No significant difference was observed in Harris score between the two groups. At the last follow-up, 28 of 36 hips were at the same radiographic stages as pre-operation, and 8 deteriorated in the rod implanted group. 26 of 34 hips were at the same radiographic stage as pre-operation, and 8 deteriorated in the small drill holes group. No significant difference was observed in radiographic stage between the two groups. There was no favourable result on the outcome of a tantalum intervention implant compared to multiple small drill holes. Discussion: CD via multiple small drill holes would allow similar postoperative load-bearing and seems to result in similar or even better clinical outcome without the prolonged implantation of an expensive tantalum implant. A tantalum rod intervention and core decompression using multiple small drill holes were effective on the stage I hips rather than stage II hips.

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 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.

Retrospective Analysis of Core Decompression in Avascular Necrosis of the Femoral Head in Patients with Sickle Cell Disease.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2108-2108
Author(s):  
Austin Cail ◽  
Kavita Natrajan ◽  
Nadine Barrett ◽  
Latanya Bowman ◽  
Betsy Clair ◽  
...  
Keyword(s):  
Femoral Head ◽  
Sickle Cell ◽  
Hip Replacement ◽  
Symptom Relief ◽  
Core Decompression ◽  
Cell Disease ◽  
X Ray ◽  
The Core ◽  
Number Of Patients

Abstract Abstract 2108 Avascular necrosis (AVN) of the femoral head is a common complication of sickle cell disease (SCD) and is estimated to occur in approximately 50% of patients with SCD by age 35. AVN is associated with significant morbidity including debilitating pain and disability. Total hip replacement (THR) is a common intervention for AVN; however, complications of hip replacement such as infections, bone fractures, prolonged healing times, and the need for subsequent revisions begs for an alternate intervention in the young SCD patient population. Core decompression is one such intervention but there has not been a common consensus on its efficacy and few studies have analyzed its role in SCD associated AVN. Our retrospective study analyzes the long term outcomes of core decompression in SCD patients. Records of 100 patients with AVN followed at the Adult Sickle Cell Clinic at Georgia Health Sciences University were reviewed. Twenty-three patients (30 hips) had core decompression (13 female, 10 male). Of these, 21 were Hb SS, 1 was Hb Sβ+ Thalassemia, and 1 was Sβ° Thalassemia. Patient demographics, age at diagnosis, Ficat stage at diagnosis, age at core, Ficat stage at core, symptom relief, THR, time to THR, and duration of follow up were recorded. The age of the patients at the time of the coring procedure ranged from 18–42 years, with a mean age (±SD) of 26.2 ±6.6. Patients had a mean (±SD) follow up period of 10.0±7.2 years after the core decompression. At the time of coring, 6 hips were stage I (x-ray normal, MRI abnormal), 20 hips were stage II (sclerosis and lytic areas on x-ray), 3 hips were stage III (femoral head flattening and crescent sign), and 1 hip did not have data available. 23/29 (79%) hips had symptom relief. Of these, 5/6 stage I, 16/19 stage II (1 hip was only 1 month post-op so was not included), 1/3 stage III, and 1/1 for the hip without the stage information available. Two of these hips that had symptom relief did eventually have THR (71 and 157 months after core). Five of these hips underwent re-coring procedures (4, 6, 6, 7, and 13 years after 1st core) and none of these went on to THR. Of the 6/29 hips that had no relief from the core, 4 went on to THR (range 5–20 months, mean=11.5± 7.2 months median=10.5 months) and 2 have been advised of the need for THR and/or are currently considering it (both currently stage IV). Including the 2 hips that were determined to be successful in relieving symptoms that had THR, there were 6/29 hips that had THR, and the time to THR ranged from 5–157 months, mean=45.7±59.8 months, median= 17.5 months. Our data suggests that core decompression is a practical option for SCD patients with early stage AVN of the femoral head. If our results pan out across multiple Sickle Cell Centers, core decompression can provide significant pain relief and delay the need of THR greatly reducing morbidity from chronic pain and improving functional outcomes. Our data, however, are contrary to the results of a multi-center study of core decompression which compared physical therapy and core decompression to physical therapy alone in 35 patients with SCD in which the follow-up period was only three years. In contrast, the strength of our study is the mean follow-up of ten years. Age range of patients from our study did not differ from that of the multicenter study. Data collection on a larger number of patients from multiple centers, perhaps in the form of a registry or a randomized trial with adequate number of patients to answer the question of the value of core decompression in SCD might be informative in this regard. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Non Traumatic Hip Osteonecrosis Treated By Non Vascularised Bone Graft Versus Core Decompression

2016 ◽  
Vol 12 (2) ◽  
pp. 49-55
Author(s):  
Dhary F. Hassan ◽  
Ghadeer H. Majeed ◽  
Abed Falih Al-Sudani
Keyword(s):  
Femoral Head ◽  
Early Diagnosis ◽  
Bone Graft ◽  
Bone Grafting ◽  
Core Decompression ◽  
Cancellous Bone Graft ◽  
Group A ◽  
Group B ◽  
Vascularized Bone

Background: Avascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply; the bone structures then collapse, resulting in bone destruction, pain, and loss of joint function. AVN is associated with numerous conditions and usually involves the epiphysis of long bones, such as the femoral head. In clinical practice, AVN is most commonly encountered in the hip. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course. Without treatment, the process is almost always progressive, leading to joint destruction within 5 years.Treatment of a vascular necrosis depends mainly on early diagnosis which mainly based on clinical findings, x-ray finding & MRI.A variety of non vascularized bone grafting techniques have been proposed with varying degrees of success as treatment alternatives for osteonecrosis of the femoral head. The success of these procedures may be enhanced using ancillary growth and differentiation factors. Objectives: To treat non traumatic hip osteonecrosis by non vascularized bone graft versus core decompression. Type of the study: A retrospective study. Methods: We retrospectively reviewed 72 patients (88 hips) with osteonecrosis of the femoral head between May 2009, and March 2014,divided into two groups . Group A include 34 patients (44 hips) with osteonecrosis of the femoral head who had non vascularized bone grafting procedures done for them . Minimum follow-up was 12 months. We compared the outcomes in this cohort to similar hip number (44 hips) in 40 patients treated with core decompression only (group B). We used Phemister technique to make a window at the posterior aspect of greater trochanter to remove necrotic bone and packed the excavated area with autogenous cancellous bone graft taken from ipsilateral iliac crest or leave it without bone graft (decompression only). Results: We report the result of treatment for femoral head avascular necrosis depending on Ficat classification stage I, II, & III. The minimum follow up was 12 months (12m-36m). The success percentage of hips in our cohort of patients with non vascularized bone grafting group A are 86% (38 of 44 hips), which is higher than group B 63% (28 of 44 hips) with core decompression alone. Conclusions: These procedures core decompression and autogenous cancellous bone graft may defer joint arthroplasty in selected patients & it is more effective than core decompression alone in treating early stages of femoral head osteonecrosis.

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