Core Decompression for Osteonecrosis of the Femoral Head

Dc, Markel; Miskovsky, C; Tp, Sculco; Pm, Pellicci; Ea, Salvati

doi:10.1097/00003086-199602000-00031

Cited by 65 publications

(33 citation statements)

References 27 publications

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“…In our series of CD, overall success rates for hips in Steinberg stages 0-II are 82% after 2 years, 57% after 4 and 50% after 6 years. Although the follow-up periods are different, these figures are comparable to those reported by Powell et al [23] and Warner et al [31], better than those reported by Camp et al [1], Hobson et al [8], Learmonth et al [16], Markel et al [18], Kristensen et al [15], but worse than those reported by Fairbank et al [3], Lederer and Knahr [17] and Smith et al [25].…”

Section: Discussionsupporting

confidence: 72%

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Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

Simank

Brocai

Strauch

et al. 1999

International Orthopaedics

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The results of core decompression of the femoral head in the treatment of osteonecrosis are analyzed. This study includes 94 hips in 74 patients with a followup time ranging between 18 months and 15 years (average 6 years). There had been no need for further surgery 2 years postoperatively in 85% of the hips with preoperative Steinberg stages 0, I and II when compared with 66% with preoperative stages III, IV and V. At 4 years postoperatively the corresponding figures are 73 compared to 55%; and 6 years postoperatively 69 compared to 49%. This difference was significant (P=0.0402). Further significant risk factors are corticosteroid administration, smoking and alcohol intake. The results of core decompression are good when the preoperative lesion is at Steinberg stage 0, I and II and the patient does not present with other risk factors. In cases with risk factors the outcome is significantly less good. The procedure is not indicated in the presence of advanced disease.Résumé Dans cette étude nous avons analysé les résul-tats de la décompression de la tête fémorale chez des patients avec ostéonécrose de la tête du fémur. 94 hanches de 74 patients ont été analysées. La durée de suivi a varié entre 18 mois et 15 ans. Deux ans après la décom-pression les résultats ont été satisfaisants (aucune reintervention chirurgicale) dans 85% des cas avec une nécrose préoperatoire dans les stades de Steinberg 0, I ou II. Avec les stades III, IV ou V les résultats ont été satisfaisant dans 66% des cas. Quatre ans après la décompres-sion les résultats satisfaisant ont été 73% (0, I ou II) et 55% (III, IV ou V). Six ans après la décompression les résultats satisfaisant ont été 69% et 49%. Les traitements avec corticoide, l'alccol et la nicotine augmentent le risque d'une ré intervention chirurgicale après la decompression d'une maniére significative. Les résultats de la decompréssion sont bons, si la 1ésion de la nécrose n'excéde pas le stade II de Steinberg et s'il n'a pas autres facteurs risque. Avec des facteurs de risque les résultats dé-clinent significativement. Dans les stades de Steinberg III, IV ou V la décompression n'est pas indiquée. IntroductionOsteonecrosis of the femoral head (ONFH) is a disease of unknown pathology. The natural history normally progresses to femoral head arthrosis with the need for total hip replacement (THR) [4]. Nonoperative treatment, such as limited weight-bearing, has been shown to be of little value. About 80% of conservatively treated patients require THR [21]. Core decompression (CD) is a treatment option that has been in use since the 1960s [4,10]. Although widely used, published clinical results are inconsistent and range from disappointing [1,8,14] to encouraging [3,25,27].This study was undertaken to evaluate the postoperative success of CD as judged by the need for re-operation, radiographic progression and clinical outcome, by using survivorship analysis. Patients and methodsIn 1997 we performed a retrospective study of patients who had undergone a CD procedure as treatment fo...

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Section: Discussionsupporting

confidence: 72%

“…During the first 6 years we observed deterioration in all subgroups of our study population. Some of the disparity in the results following CD might be explained by the fact that most of the published studies do not use survivorship analysis and life tables when describing their results [8,[16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

Simank

Brocai

Strauch

et al. 1999

International Orthopaedics

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“…In a systematic literature review, Marker et al [12] evaluated the clinical and radiographic outcomes of core decompression in surgeries done before [13][14][15][16][17][18][19][20][21][22] and after 1992 [1,2,10,[23][24][25][26][27][28][29][30][31] (n=1268 and 1337 hips, respectively). The authors demonstrated that in procedures performed before 1992, 41 % of hips required additional surgery after a mean follow-up of 65 months (range, 3 to 216 months).…”

Section: Overall Outcomes Of Traditional Core Decompressionmentioning

confidence: 99%

A current review of core decompression in the treatment of osteonecrosis of the femoral head

Pierce

Jauregui

Elmallah

et al. 2015

Curr Rev Musculoskelet Med

102

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The review describes the following: (1) how traditional core decompression is performed, (2) adjunctive treatments, (3) multiple percutaneous drilling technique, and (4) the overall outcomes of these procedures. Core decompression has optimal outcomes when used in the earliest, precollapse disease stages. More recent studies have reported excellent outcomes with percutaneous drilling. Furthermore, adjunct treatment methods combining core decompression with growth factors, bone morphogenic proteins, stem cells, and bone grafting have demonstrated positive results; however, larger randomized trial is needed to evaluate their overall efficacy.

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“…Based on the pathogenetic assumption of a compartment syndrome of the femoral head the therapeutic principle of core decompression was established [5,4,2]. There is controversy in the literature about how effective this therapeutic procedure is [5,9,11,12,13,16,20,24]. The aim of this study was to assess the efficacy of core decompression in early stages of osteonecrosis of the femoral head.…”

Section: Introductionmentioning

confidence: 99%

Core decompression in early stages of femoral head osteonecrosis – an MRI-controlled study

Aigner

Schneider

Eberl

et al. 2002

International Orthopaedics (SICOT)

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We treated 45 hips with idiopathic necrosis of the femoral head stages I-III with core decompression. Average age of patients was 41 (27-68) years and average follow-up 68.9 (31-120) months. In 30 hip joints in stage I, 29 showed no radiographic progression and a complete remission of the changes consistent with necrosis on MRI at the last follow-up. In 27 patients the clinical resultbased on the Harris Hip Score (HHS) assessment -was excellent (average HHS 91.9 points). Of nine hips in stage II, four had received a total hip arthroplasty, one had deteriorated to stage IV, and four were still classified as stage II (average HHS 95 points). Of six hips in stage III, three had received a total hip arthroplasty and three had deteriorated to stage IV (average HHS 73 points).Résumé Nous avons traité 45 hanches présentant une nécrose idiopathique de la tête fémorale de stade I-III par décompression. L'âge moyen des malades était de 41 (27-68) ans et le temps moyen de suivi de 68,9 (31-120) mois. Pour 30 hanches de stade I, 29 n'ont montré aucune progression radiographique au dernier recul et une complète regressiondes des anomalies IRM. Chez 27 malades le résultat clinique était excellent (HHS moyen 91,9 points). De neuf hanches au stade II,quatre avait reçu une arthroplastie totale, une s'était aggravée au stade IV et quatre étaient encore classées comme stade II (HHS moyen 95 points). De six hanches au stade III, trois avait reçu une arthroplastie totale et trois s'étaient aggraveés au stade IV (HHS moyen 73 points).

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Core Decompression for Osteonecrosis of the Femoral Head

Cited by 65 publications

References 27 publications

Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

A current review of core decompression in the treatment of osteonecrosis of the femoral head

Core decompression in early stages of femoral head osteonecrosis – an MRI-controlled study

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