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.

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.

scholarly journals Autologous Stem Cells Combined Core Decompression for Treatment of Avascular Necrosis of the Femoral Head: A Systematic Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Shibing Xu ◽  
Lei Zhang ◽  
Hongting Jin ◽  
Letian Shan ◽  
Li Zhou ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Femoral Head ◽  
Avascular Necrosis ◽  
Meta Analysis ◽  
Core Decompression ◽  
Autologous Bone Marrow ◽  
Bone Marrow Stem Cells ◽  
Harris Hip Score ◽  
Autologous Bone

Objective. This study aims to systematically evaluate the efficacy and safety of core decompression combined transplantation of autologous bone marrow stem cells (CDBMSCs) for treatment of avascular necrosis of the femoral head (ANFH). Methods. Randomized controlled trials (RCTs) regarding effectiveness of core decompression combined transplantation of autologous bone marrow stem cells for treating ANFH were searched in 8 comprehensive databases prior to September 2016. The data analysis was performed by using the RevMan version 5.3. Results. A total of 11 studies with 507 participants were included. Results showed that CDBMSCs group was more effective than CD group in increasing Harris hip score, decreasing necrotic area of femoral head, collapse of femoral head, and conversion to total hip replacement incidence. In the subgroup analysis, the results did not change in different intervention measure substantially. In addition, the safety of CDBMSCs for ANFH is reliable. Conclusion. Based on the systematic review, our findings suggest that core decompression combined transplantation of autologous bone marrow stem cells appeared to be more efficacious in the treatment at early stages of ANFH.

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

2012 ◽  
Vol 7 (11) ◽  
pp. 893-900 ◽  
Author(s):  
Stefan Landgraeber ◽  
Jens M. Theysohn ◽  
Tim Classen ◽  
Marcus Jäger ◽  
Sebastian Warwas ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Treatment Option ◽  
Core Decompression ◽  
New Treatment

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.

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.

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 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.

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

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