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

Landgraeber, Stefan; Theysohn, Jens; Claßen, Tim; Jäger, Markus; Warwas, Sebastian; Hohn, H.P.; Kowalczyk, Wojciech

doi:10.1002/term.1481

Cited by 42 publications

(43 citation statements)

References 42 publications

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“…All patients underwent ACD at the Department of Orthopaedics of the University of Duisburg-Essen. All procedures were performed by one surgeon according to the surgical technique described previously [12]. To avoid the influence of the learning curve, the surgeon had already performed ten ACDs prior to the study.…”

Section: Methodsmentioning

confidence: 99%

“…In the first pilot study, it was surmised that the X-REAM Ò may not enable complete removal of the necrosis [12]. Furthermore, remaining necrotic tissue was observed in nearly all of the cases included in that study.…”

Section: Introductionmentioning

confidence: 98%

“…The outcome of ACD is reported to be better for small necrotic defects than for larger defects [12]. In the first pilot study, it was surmised that the X-REAM Ò may not enable complete removal of the necrosis [12].…”

Section: Introductionmentioning

confidence: 99%

“…''Advanced core decompression'' (ACD) is a new option for treatment of ONFH that may fulfil this requirement [12]. It is based on the conventional core decompression technique, but is performed using a new percutaneous expandable reamer (X-REAM Ò , Wright Medical Technology TM , Inc. Arlington, TN, USA).…”

Section: Introductionmentioning

confidence: 99%

“…1). After removal of the necrotic tissue, the drill hole and the defect are refilled with an osteoconductive, injectable bone-graft substitute consisting of calcium sulphate (CaSO 4 )-calcium phosphate (CaPO 4 ) (PRO-DENSE Ò , Wright Medical Technology TM , Inc. Arlington, TN, USA) [5,12].…”

Section: Introductionmentioning

confidence: 99%

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Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head

Landgraeber

Tran

Claßen

et al. 2015

Arch Orthop Trauma Surg

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"Advanced core decompression" (ACD) is a treatment option for osteonecrosis of the femoral head (ONFH) that aims at complete removal of the necrotic tissue using a percutaneous expandable reamer and refilling of the head with an osteoconductive bone-graft substitute. The objective of this study was to evaluate if the success of ACD depends on the amount of necrotic tissue remaining after the procedure and how efficiently the necrotic tissue can be removed with the current reamer. Three-dimensional models of proximal femora including ONFH were generated from the preoperative MRIs of 50 patients who underwent ACD. Best-case removal was calculated by geometrical analysis. In 28 of 50 cases, postoperative MRI was used to determine how much necrotic tissue had been removed. Prognostic values and correlations were evaluated in order to assess success or failure of the treatment. The amount of preoperative and remaining necrosis correlates significantly with treatment failure. The larger both volumes are, the more likely it is that treatment will fail. In patients with remaining necrosis of less than 1000 mm(3), no treatment failure was observed. The amount of necrosis actually removed differed significantly from the amount calculated as the best possible result. Simulation of the removal procedure showed that complete removal is not possible. These results led to the conclusion that the success of ACD depends on the amount of necrotic tissue remaining in the femoral head after the procedure. Modifications to the instrument are necessary to increase the amount of necrotic tissue that can be removed.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head

Landgraeber

Tran

Claßen

et al. 2015

Arch Orthop Trauma Surg

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Bone tissue engineering for treating osteonecrosis of the femoral head

Bian

et al. 2023

Exploration

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Osteonecrosis of the femoral head (ONFH) is a devastating and complicated disease with an unclear etiology. Femoral head-preserving surgeries have been devoted to delaying and hindering the collapse of the femoral head since their introduction in the last century. However, the isolated femoral head-preserving surgeries cannot prevent the natural progression of ONFH, and the combination of autogenous or allogeneic bone grafting often leads to many undesired complications. To tackle this dilemma, bone tissue engineering has been widely developed to compensate for the deficiencies of these surgeries. During the last decades, great progress has been made in ingenious bone tissue engineering for ONFH treatment. Herein, we comprehensively summarize the state-of-the-art progress made in bone tissue engineering for ONFH treatment. The definition, classification, etiology, diagnosis, and current treatments of ONFH are first described. Then, the recent progress in the development of various bone-repairing biomaterials, including bioceramics, natural polymers, synthetic polymers, and metals, for treating ONFH is presented. Thereafter, regenerative therapies for ONFH treatment are also discussed. Finally, we give some personal insights on the current challenges of these therapeutic strategies in the clinic and the future development of bone tissue engineering for ONFH treatment. K E Y WO R D S biomaterials, bone tissue engineering, osteonecrosis of the femoral head, regenerative therapy  Yixin Bian and Tingting Hu contributed equally to this work.

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Two-year follow-up after advanced core decompression

Claßen

Warwas

Jäger

et al. 2015

J Tissue Eng Regen Med

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The so-called "Advanced Core Decompression" (ACD) is a new option that tries to remove the necrotic tissue in patients with osteonecrosis of the femoral head (AVN) in a minimally invasive way by the use of a percutaneous expandable reamer and refilling with a resorbable and osteoinductive bone-graft substitute. Seventy-two hips of sixty patients with a mean follow-up of 29.14 months after ACD have been included in this study. Patients underwent physical examination preoperatively and six weeks after surgery as well as at two further follow-ups. Certain phases in disease progression and size of the necrotic lesion were differentiated on the basis of the classification of osteonecrosis of the femoral head by Steinberg.The femoral heads had collapsed in 24 cases (33%). Analysis of the survival rates with regard to defect size revealed that the largest defects had a significantly higher rate of femoral head collapse than the smaller defects. Clinical scores were also depending on defect size but also on disease stage. The current ACD technique has not yet achieved any significant improvement in the success rate of core decompression procedures. It can be concluded that the success of ACD depends especially on the defect size. Copyright © 2015 John Wiley & Sons, Ltd.

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

Cited by 42 publications

References 42 publications

Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head

Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head

Bone tissue engineering for treating osteonecrosis of the femoral head

Two-year follow-up after advanced core decompression

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