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

Abstract

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).

Cost-effectiveness Analysis of Core Decompression

“…Limited data exist in the literature documenting successful results in controlled trials at 5-and 10-year follow-up on patients that have undergone core decompression of the hip. Existing studies have indicated promising results that meet or exceed these goals after core decompression, but control groups are often inadequate [1][2][3][4][5][6][7][8][9][10][11]. More rigorous evaluation of core decompression is required to document its true efficacy and resulting cost-effectiveness.…”

“…As a result, core decompression is likely to have poor cost-effectiveness in these cases of latestage disease. Patients with extensive femoral head involvement or a history of long-term steroid use are also likely to demonstrate clinical efficacy below these levels [3][4][5][6][7][8][9][10][11]. The use of core decompression in these subgroups is not supported in this analysis.…”

“…The cost-effective indications for continued use of this procedure in early-stage disease will be more clearly delineated when results above this threshold are documented in controlled long-term clinical trials. All articles have greater than 50 subjects, with the exception of the study of Aigner et al [4], which was included based on having 45 subjects and meeting all other quality criteria. …”

“…There has been a wide range of results reported on the efficacy of core decompression [3][4][5][6][7][8][9][10][11]. The clinical results abstracted from the literature review are summarized in Appendix A.…”

“…The primary complication included in the model following core decompression is subtrochanteric hip fracture requiring operative intervention. This complication has been infrequently reported, but rates as high as 5% have been published [3][4][5][6][7][8][9][10][11]. An intermediate value of 2% was selected for the reference case, and sensitivity analysis was used to examine the effect of rates in the range of 0% to 5%.…”