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The results of the study affirm the relevance of hip preserving surgery, especially in younger-aged groups.

SummaryThe treatment of femoral head necrosis of adults is still rather problematic. Conservative treatment has been reported relatively unsuccessful and surgical treatment does not show convincing results either. The most effective seems to be a surgical treatment in early stages of the disease, however, the diagnosis still remains relatively complicated. For the late stages (2B and above) the most effective treatment option is represented by core decompression and vascular grafting. However, drilling and plombage (especially when using press-fit technique) seems to be successful, although not excellent. The authors describe their own method of drilling and plombage of the necrotic zone of the femoral head in 41 patients with X-ray detected necrotic changes of the femoral head. The pain measured by VAS was seen to decrease after surgery in all patients significantly. The Jacobs score was also observed to have increased (from fair to good outcome). We have not observed any large femoral head collapse after surgery, moreover, in some cases an improvement of the round shape of the femoral head was seen. It is important to mention that in all cases femoral heads with existing necrotic changes (flattening or collapse) were treated. Although the clinical improvement after surgery was not significantly high, the method we describe is a safe and simple method of diminishing pain in attempt to prepare the femoral head for further treatment in a future, without significant restriction of the indication due to necrosis (osteochondroplasty, resurfacing, THR).

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PURPOSE OF THE STUDYFemoroacetabular impingement syndrome (FAI) represents a mechanical conflict between acetabulum and proximal part of the femur. This disorder may gradually result in the development of the hip osteoarthritis. FAI may be caused by an acetabular retroversion, rarely by coxa profunda or by asphericity of the femoral head and missing femoral head-neck offset respectively. However, a combination of both conditions is the most frequent.Before FAI treatment was adopted as a standard technique for hip preservation at our department, detailed cadaver studies of the vascular anatomy of the hip were performed and the relevant literature was reviewed. The aim of this study was to assess the efficiency of hip preserving surgery in relation to the technique used. We hypothesized that surgical intervention helped to alleviate pain and improve hip function.