Does augmented core decompression decrease the rate of collapse and improve survival of femoral head avascular necrosis? Case-control study comparing 184 augmented core decompressions to 79 standard core decompressions with a minimum 2 years’ follow-up

Martinot, Pierre; Dartus, Julien; Justo, Arthur; Riouach, Hicham; Cremer, Paul; Flouzat-Lachaniette, Charles-Henri; Hernigou, Philippe; Kerboull, L.; Chiron, Philippe

doi:10.1016/j.otsr.2020.03.040

Cited by 9 publications

(9 citation statements)

References 36 publications

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“…The introduction of grafts often requires larger drilling, up to 9 mm with expandable reamers [38], the so-called advanced core decompression to remove the necrotic tissue [18]. The introduction of grafts has been claimed to be superior to standard CD procedures in a large series at 10 years when adjusted for Ficat stage [39], even if the clinical relevance is limited (58.1 vs. 57.9% 10-year survivorship). However, the size of the lesion may be a determinant when selecting this more aggressive technique.…”

Section: Central Posteriormentioning

confidence: 99%

Implantation of autologous Expanded Mesenchymal Stromal Cells in Hip Osteonecrosis through Percutaneous Forage: Evaluation of the Operative Technique

Gómez‐Barrena

Padilla-Eguiluz

2021

JCM

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Bone forage to treat early osteonecrosis of the femoral head (ONFH) has evolved as the channel to percutaneously deliver cell therapy into the femoral head. However, its efficacy is variable and the drivers towards higher efficacy are currently unknown. The aim of this study was to evaluate the forage technique and correlate it with the efficacy to heal ONFH in a multicentric, multinational clinical trial to implant autologous mesenchymal stromal cells expanded from bone marrow (BM-hMSCs). Methods: In the context of EudraCT 2012-002010-39, patients with small and medium-sized (mean volume = 13.3%, range: 5.4 to 32.2) ONFH stage II (Ficat, ARCO, Steinberg) C1 and C2 (Japanese Investigation Committee (JIC)) were treated with percutaneous forage and implantation of 140 million BM-hMSCs in a standardized manner. Postoperative hip radiographs (AP—anteroposterior and lateral), and MRI sections (coronal and transverse) were retrospectively evaluated in 22 patients to assess the femoral head drilling orientation in both planes, and its relation to the necrotic area. Results: Treatment efficacy was similar in C1 and C2 (coronal plane) and in anterior to posterior (transverse plane) osteonecrotic lesions. The drill crossed the sclerotic rim in all cases. The forage was placed slightly valgus, at 139.3 ± 8.4 grades (range, 125.5–159.3) with higher dispersion (f = 2.6; p = 0.034) than the anatomical cervicodiaphyseal angle. Bonferroni’s correlation between both angles was 0.50 (p = 0.028). More failures were seen with a varus drill positioning, aiming at the central area of the femoral head, outside the weight-bearing area (WBA) (p = 0.049). In the transverse plane, the anterior positioning of the drill did not result in better outcomes (p = 0.477). Conclusion: The forage drilling to deliver cells should be positioned within the WBA in the coronal plane, avoiding varus positioning, and central to anterior in the transverse plane. The efficacy of delivered MSCs to regenerate bone in ONFH could be influenced by the drilling direction. Standardization of this surgical technique is desirable.

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Section: Central Posteriormentioning

confidence: 99%

Implantation of autologous Expanded Mesenchymal Stromal Cells in Hip Osteonecrosis through Percutaneous Forage: Evaluation of the Operative Technique

Gómez‐Barrena

Padilla-Eguiluz

2021

JCM

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“… 29 Conservative treatment is appropriate for patients in Ficat stages I or IIa; the effect of core decompression is evident in patients with femoral head cysts and dead bone in Ficat stage IIb. 30 , 31 Patients with Ficat stages III and IV are contraindicated for conservative treatment and require total hip arthroplasty in the majority of cases. 32 Following conservative treatment and core decompression, patients with osteonecrosis of the femoral head should undergo routine X-ray and computed tomography examinations; if the condition worsens, a total hip replacement may be necessary.…”

Section: Discussionmentioning

confidence: 99%

Femoral Head Necrosis Due to Brucella Infection in China: Case Series and Literature Review

Wang¹,

Zhang²,

Zhao³

et al. 2022

IDR

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Introduction The causes of femoral head necrosis mainly include trauma, corticosteroid, and alcohol, among which Brucella is highly unusual. Patients and Methods This paper reported three rare cases of femoral head necrosis due to Brucella , summarizing and analyzing the epidemiological history, clinical manifestations, laboratory examinations, imaging findings, individualized therapy, and biopsy results of patients with this disease. A literature review related to brucellosis and femoral head necrosis was conducted. Results All three patients had an epidemic history of brucellosis. They suffered from hip pain and limitation of movement for months, and femoral head necrosis was confirmed by magnetic resonance imaging (MRI). Pathological Giemsa staining or real-time polymerase chain reaction (real-time PCR) confirmed Brucella melitensis ( B. melitensis ) as the cause of osteonecrosis. Each patient received individualized therapy according to the degree of osteonecrosis, which was based on anti-brucellosis medications and hip puncture and irrigation decompression. They were followed up for more than two years and rehabilitated well. Conclusion Brucella infection should always be considered the cause of femoral head necrosis for patients with hip pain, especially for those with an epidemic history; early diagnosis and individual stepwise therapy can prevent the progression of osteonecrosis.

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“…The reasons may be as follows: (1) The pathological mechanism of FHC in hormonal osteonecrosis after porous tantalum rod implantation treatment may be that the head of the femur collapses as a result of hormones causing disturbances in lipid metabolism and increased activity and number of osteoclasts, leading to a reduction in the biomechanical properties of the subchondral bone. 12 (2) When the necrotic area is large, the support area of the porous tantalum rod is small, which can easily lead to the collapse of the necrotic area, and if the necrotic area is located in the weight-bearing area, the external bone death will reduce the mechanical strength and weight-bearing capacity of the FH, destroying the normal mechanical stability of the FH and aggravating the collapse of the FH. 19 (3) Types C1 and C2 of the Japanese Society for the Study of Femoral Osteonecrosis typology suggest that the mechanical support structure of the subchondral bone of the FH has been severely damaged, particularly in type C2, with a high frequency of collapse.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Factors Influencing Postoperative Femoral Head Collapse in Patients With Ficat I, II, and III Stages of Aseptic Necrosis of the Femoral Head

Zhang

Cao

et al. 2022

J Am Acad Orthop Surg

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Objective: To investigate the factors influencing postoperative femoral head collapse (FHC) in patients with Ficat I, II, and III stages of aseptic necrosis of the femoral head (ANFH). Methods: Retrospective analysis of 178 patients with ANFH admitted to our hospital from October 2018 to October 2021 was studied, and patients were categorized into the FHC group and no FHC group according to whether FHC occurred after surgery. The influencing factors causing postoperative FHC were analyzed by univariate and multifactor logistic regression. Results: In the collapsed group, there were statistically significant differences in etiology, extent of necrosis, mechanism of injury, preoperative waiting time, Japanese Femoral Necrosis Research Society staging, distance from the tip of the tantalum rod to the center of necrosis, and Harris score after treatment (P , 0.05). The etiology, extent of necrosis, mechanism of injury, preoperative waiting time, Japanese Femoral Osteonecrosis Research Society classification, distance between the tantalum rod tip and the center of necrosis, and Harris score after treatment were set as independent variables, and postoperative FHC in patients with Ficat I, II, and III stages of ANFH was used as the dependent variable in the univariate logistic regression analysis. Discussion: Hormonal osteonecrosis of the femur, extent of necrosis, type C1 and type C2 in the Japanese Society for the Study of Femoral Osteonecrosis staging, and distance of the tip of the tantalum rod from the center of necrosis are risk factors for postoperative FHC in patients with Ficat I, II, and III stages of ANFH. Femoral head (FH) necrosis is a frequent and hard-to-treat orthopaedic disease among young and elderly. [1][2][3] It is mostly caused by poorly repositioned femoral neck fractures and bone tissue self-lesions, and

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Does augmented core decompression decrease the rate of collapse and improve survival of femoral head avascular necrosis? Case-control study comparing 184 augmented core decompressions to 79 standard core decompressions with a minimum 2 years’ follow-up

Cited by 9 publications

References 36 publications

Implantation of autologous Expanded Mesenchymal Stromal Cells in Hip Osteonecrosis through Percutaneous Forage: Evaluation of the Operative Technique

Implantation of autologous Expanded Mesenchymal Stromal Cells in Hip Osteonecrosis through Percutaneous Forage: Evaluation of the Operative Technique

Femoral Head Necrosis Due to Brucella Infection in China: Case Series and Literature Review

Analysis of Factors Influencing Postoperative Femoral Head Collapse in Patients With Ficat I, II, and III Stages of Aseptic Necrosis of the Femoral Head

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