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 Core decompression versus nonvascularized bone grafting in patients with osteonecrosis of femoral head

2021 ◽  
Author(s):  
Jin Mei ◽  
Lili Pang ◽  
Zhongchao Jiang
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Bone Grafting ◽  
Early Stage ◽  
Survival Rates ◽  
Core Decompression ◽  
Osteonecrosis Of Femoral Head ◽  
Independent Risk Factors ◽  
The Mean

Abstract Background Core decompression and nonvascularized bone grafting are used in the early stage of osteonecrosis of femoral head for a period. Since the comparison of the core decompression and nonvascularized bone grafting are less reported, the purpose of our study was to investigate the clinical outcomes of two procedures in patients with earlier stages of the osteonecrosis of femoral head. Methods Between January 2018 and January 2019, 46 patients (48 hips) are divided into core decompression group and non-vascularized allogeneic fibula grafting group according to their procedures. The mean follow-up were 28.31±3.7 months (24–36 months) and 29.23±4.7months(24–36 months) respectively. the primary outcomes were VAS and HHS. Survivorship was analyzed with the collapse of femoral head or conversion to total hip arthroplasty (THA) as the endpoint. Results At the final follow-up, two hips underwent THA in core decompression group and three hips in non-vascularized allogeneic fibula grafting group. The radiographic survival rates are 76.9% and 77.3% in the two groups. Statistically significant improvements were seen in both groups on the VAS and HHS. The radiographic survival rate of hips was significantly inferior in lateral type lesion (P = 0.03; CI,0.765–2.114) and ARCO III stage (P = 0.28; CI, 1.254–58.752) in core decompression group. ARCO III stage (P = 0.02; CI, 1.351–49.344) and BMI>25 (P = 0.35; CI, 0.999–2.131) were independent risk factors for the collapse of femoral head in non-vascularized allogeneic fibula grafting group. Conclusion In this study, two procedures all can reduce the patient’s pain and improve functional activity. Arco stage III is a common risk factor for the collapse of femoral head in both groups. lateral lesion and BMI>25 are risk factors for the collapse of femoral head in core decompression group and non-vascularized allogeneic fibula grafting group, respectively. Both groups had good hip survival rates during the follow-up period.

scholarly journals The Effect of Postoperative Corticosteroid Administration on Free Vascularized Fibular Grafting for Treating Osteonecrosis of the Femoral Head

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Hao Ding ◽  
Sheng-Bao Chen ◽  
Sen Lin ◽  
You-Shui Gao ◽  
Chang-Qing Zhang
Keyword(s):  
Adverse Effect ◽  
Femoral Head ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Control Group ◽  
Corticosteroid Administration ◽  
The Mean ◽  
Fibular Grafting ◽  
Free Vascularized Fibular Grafting

Free vascularized fibular grafting (FVFG) has been reported to be an effective method of treating osteonecrosis of the femoral head (ONFH). This study evaluated whether postoperative maintenance doses of corticosteroids had an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH. We retrospectively reviewed the records of 39 patients (67 hips) who had received maintenance doses of corticosteroids following FVFG. This group was matched to a group of patients who had not received corticosteroids treatment after operation. The mean follow-up duration was 5.4 years for the postoperative corticosteroid administration group (PCA group) and 5.0 years for the control group. At the latest follow-up, the average increase in Harris hip score was 11.1 ± 8.7 points for all hips in the PCA group and 12.6 ± 7.4 points for all hips in the control group (P>0.05). In the PCA group, through radiographic evaluation, 49 hips were improved, 10 hips appeared unchanged, and 8 hips appeared worse. In the control group, 47 hips were improved, 13 hips appeared unchanged, and 7 hips appeared worse. The results suggested that postoperative maintenance doses of corticosteroids do not have an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH.

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

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.

EFFICACY OF CORE DECOMPRESSION AND AUTOLOGOUS CANCELLOUS BONE GRAFTING IN AVASCULAR NECROSIS OF FEMORAL HEAD

2021 ◽  
pp. 108-110
Author(s):  
Vimal kumar bairwa ◽  
Pradeep Singh ◽  
Rakesh verma ◽  
Shivbhagwan sharma ◽  
Arvind kumar bohra
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Cancellous Bone ◽  
Bone Grafting ◽  
Core Decompression ◽  
Harris Hip Score ◽  
Age Group ◽  
Cancellous Bone Grafting ◽  
Autologous Bone Grafting ◽  
Autologous Bone

BACKGROUND: Avascular necrosis (AVN) of the femoral head is a disease that usually affects patients in the 20-50 year age group of life. The disease progresses with time and if left untreated, it may leads to complete deterioration of the hip joint. Various treatments modalities are available as non-surgical, core decompression alone or with autologous bone graft or PRP or bone marrow aspirate or vascularised bular graft, osteotomies and hip replacement. We planned to evaluate the efcacy of core decompression and autologous bone grafting in the management of AVN of the hip. MATERIALS AND METHODS- We performed a prospective study with 20 patients of 20-50 years age group having cat-arlet stage 1 [8 patients ] and 2a [12 patients]. The study period was from January 2018 to December 2019. All patients were treated with core decompression and autologous cancellous bone grafting. Pre-operative Harris hip score [HHS], plain radiograph and MRI were compared with postoperative ones at different time intervals. RESULTS- Average Follow Up Period Was 12 Months And Average Age Group Of Presentation Was 31.1 Years . Males Were More Affected And Most Common Causes Were Idiopathic And Steroid Use. Average Preoperative Hhs Was 56.20 And Postoperative Hhs Was 80.15. At The End Of 1 Year, 12 Patients Showed Remission, 6 Patients Showed Preoperative Stage While 2 Patients Progressed To Advanced Stage And Required Arthroplasty. CONCLUSION-core Decompression And Autologous Bone Grafting Is Effective Treatment Modality In Early Avascular Necrosis Of Femur Head In Terms Of Radiological And Clinical Results And Delaying Arthroplasty

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.

scholarly journals Core Decompression and Biological Treatment in Osteonecrosis of the Hip due to Systemic Lupus Erythematosus, 8-year Follow-up: A Case Report

2021 ◽  
Vol 9 (C) ◽  
pp. 74-79
Author(s):  
Sholahuddin Rhatomy ◽  
Ismail Hadisoebroto Dilogo
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Case Report ◽  
Femoral Head ◽  
Lupus Erythematosus ◽  
Biological Treatment ◽  
Core Decompression ◽  
Treatment Result ◽  
Harris Hip Score ◽  
Systemic Lupus

BACKGROUND: Osteonecrosis most commonly affects the femoral head, especially in middle-aged adults. It can be caused by trauma, chronic inflammation, or infection. It leads to collapse of the entire femoral head and culminates with total hip replacement. CASE REPORT: A 29-year-old female with systemic lupus erythematosus (SLE) had a chief complaint of bilateral hip pain. She was diagnosed with early osteonecrosis of the femoral head (FICAT stage II) using magnetic resonance imaging and core decompression surgery was performed using three small diameter (4 mm) drillings and added biological treatment. She was evaluated with a visual analog scale (VAS), Harris hip score (HHS), and plain radiography in the pre-operative stage and post-operative follow-up. RESULTS: Functional outcome at 8-year follow-up showed improvement with significantly decreased VAS (pre-operative: 5, post-operative: 0), significant improvement of HHS from 52.725 points (poor) pre-operative to 92.025 points (excellent) post-operative, and subsided femoral head lesion. CONCLUSIONS: Surgical decompression and biological treatment result in decreased intraosseous pressure and enhanced osteogenesis. It can restrict the SLE disease progression and limit the number of cell death.

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.

Sign in / Sign up

Export Citation Format

Share Document