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

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.

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

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

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

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.

Combination use of core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis using Forest and Funnel Plots

Problem statement. Core decompression (CD) is a very significant process of dealing in the treatment of femoral head necrosis. And CD combined with bone marrow mesenchymal stem cell transplantation has been widely used in clinical practice, but its effectiveness is controversial. This study is carried out to observe its efficacy and outcomes. Objective. This study evaluated the efficacy and safety of CD combined with bone marrow stem cells in the treatment of femoral head necrosis by systematic review and meta-analysis. Methodology. PubMed, The Cochrane Library, Embase, CNKI, Google Scholar and MEDLINE, etc. databases were searched for clinical randomized controlled trials (RCTs) comparing core decompression combined with autologous bone marrow mesenchymal stem cells versus core decompression alone in the treatment of femoral head necrosis. The retrieval period is from the establishment of each database to May 20, 2021. After literature was extracted and literature quality was evaluated, meta-analysis was conducted by using RevMan5.3 software. Results. A total of 420 osteonecrosis of the femoral head 452 patients' data were collected from all studies. Compared with the core decompression alone group, the CD combined with bone marrow stem cell showed marked reduction in the Visual analog scale (VAS), enhanced Harris hip score (HHS) at 12 months and 24 months, slowed down the progression of the disease, decreased the number of hips conversed to total hip arthroplasty (THA) in the future. Conclusion. Core decompression therapy is a very effective and safe treatment process used for ONFH. Moreover, CD combined autologous bone marrow stem cell transplantation can improve the survival rate of the necrotic head, reduce hip pain and delay the disease progression, the rate of THA postoperatively.

Robot-assisted core decompression combined with bone grafting can improve the early clinical results in femoral head necrosis: a prospective cohort study

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

Efficacy of various core decompression techniques versus non-operative treatment for osteonecrosis of the femoral head: a systemic review and network meta-analysis of randomized controlled trials

Background Various Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial. The purpose of this study is to evaluate its effectiveness and whether there are statistical differences in treatment between different interventions based on published RCT studies. Methods Following the PRISMA-NMA checklist, Medline, EMBASE, Web of Science, and Cochrane Library databases were searched and collected related RCT studies. The sources were searched from inception up to October 30, 2020. The primary outcomes including the rate of radiographic progression and conversion to THA and the secondary outcome -Harris Hip Scores (HHS) were extracted and compared in a Network meta-analysis. Results Seventeen RCT studies involving 784 patients (918 hips) with seven interventions including CD (core decompression), CD + BG (bone graft), CD + TI (tantalum rod implantation), CD + CT (Cell therapy), CD + BG + CT, VBG (vascularized bone graft), and nonsurgical or conservative treatment for ONFH were evaluated. In the radiographic progression results, CD + CT showed a relatively better result than CD, CD + BG and non-surgical treatment, the surface under the cumulative ranking curve (SUCRA) plot displayed that CD + CT (96.4%) was the best, followed by CD (64.1%).In conversion to THA results, there were no significant differences between the JPT methods and non-surgical treatment. In HHS, there was also no significant difference, other than CD + BG showed a statistical difference than non-surgical treatment only in terms of Cis, but the SUCRA was highest in non-surgical treatment (80.5%) followed by CD + CT (72.8%). Conclusions This Net-work meta-analysis demonstrated that there was no statistical difference in the outcome of radiographic progression and conversion to THA, also in HHS, other than CD + CT showed a relatively superior result in radiographic progression than nonsurgical treatment, namely, it’s maybe an effective method for delaying disease progression or reducing disease development based on current evidence.

Avascular Osteonecrosis of the Talus: Current Treatment Strategies

Avascular osteonecrosis (AVN) of the talus (AVNT) is a painful and challenging clinical diagnosis. AVNT has multiple known risk factors and etiologies and presents at different stages in severity. Given these unique factors, the optimal treatment solution has yet to be determined. Both joint-preserving and joint-sacrificing procedures are available, including core decompression and arthrodeses. Recently, new salvage and replacement techniques have been described including vascularized pedicle bone grafts and total talus replacement using patient-specific prosthesis; however, evidence remains limited. This review examines the current trends AVNT treatment and the emerging data behind these novel techniques.