Does Lesion Size Affect the Outcome in Avascular Necrosis?

Steinberg, Marvin E.; Bands, Roy; Parry, Scott; Hoffman, Eric W.; Chan, Teresa W.; Hartman, Karen M.

doi:10.1097/00003086-199910000-00033

Cited by 132 publications

(81 citation statements)

References 21 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Decision Modelmentioning

confidence: 99%

“…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%.…”

Section: Decision Modelmentioning

confidence: 99%

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Cost-effectiveness Analysis of Core Decompression

SooHoo

Vyas

Manunga

et al. 2006

The Journal of Arthroplasty

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Core decompression is widely used to treat the early stages of osteonecrosis of the hip. The purpose of this analysis is to assist orthopedic surgeons in judging whether currently available data support the use of core decompression as cost-effective. A decision model was created for the treatment of osteonecrosis of the femoral head. Literature review was used to identify possible outcomes and their probability after initial treatment with either observation or core decompression. This model demonstrates core decompression must delay the need for total hip arthroplasty for a minimum of 5 years to maintain an incremental cost-effectiveness ratio lower than $50 000 per quality-adjusted life year gained. Treatment options with ratios higher than $50 000 per quality-adjusted life year are generally considered to have limited cost-effectiveness. This study demonstrates that core decompression has the potential to be a highly cost-effective alternative if it is leads to a delay in the need for total hip arthroplasty of 5 years or longer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Decision Modelmentioning

confidence: 99%

Section: Decision Modelmentioning

confidence: 99%

See 2 more Smart Citations

Cost-effectiveness Analysis of Core Decompression

SooHoo

Vyas

Manunga

et al. 2006

The Journal of Arthroplasty

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“…The size of necrotic segement, whether it has collapsed, influences the success rate of femoral head preservable procedures 10) . In our patient, his symptoms were severe and radiographic findings showed rapidly progressive collapse.…”

Section: Discussionmentioning

confidence: 99%

Avascular Necrosis of Femoral Head Treated by Total Hip Replacement in AIDS Patients - A Case Report -

et al. 2007

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The incidence of osteonecrosis of the femoral head is increasing in patients infected with the human immunodeficiency virus (HIV). The etiology of osteonecrosis in HIV positive patients is multifactorial. The factors considered responsible include antiretroviral therapy, corticosteroid use and resultant hyperlipidemia, hypercoagulability, immune reconstitution, the increased prevalence of alcoholism in this population and megesterol acetate. The emergence of the HIV has highlighted the need for surgeons to understand the epidemiology of percutaneous injuries and other blood exposure in a surgical setting. We report a case of avascular necrosis of the hip treated with a total hip replacement, with particular focus on the etio-pathology of the disease and preventive measures for its transmission in an orthopedic surgery setting.

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Frog leg lateral view is a reliable predictor of the prognosis in osteonecrosis of the femoral head

Cheng

Xian

Wang

et al. 2020

Journal Orthopaedic Research

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The location and size of necrotic lesions are primary factors that predict the prognosis in osteonecrosis of the femoral head (ONFH). The Japanese Investigation Committee (JIC) classification system, based on the location of the necrotic lesion, has been widely accepted and applied around the world. However, there is no report about whether the location of the necrotic area in lateral view may affect the prognosis predicted initially by the JIC classification. The purpose of this study was to investigate whether the location of the necrotic area in the frog leg lateral (FL) view would affect the prediction of prognosis for patients with ONFH. We retrospectively studied 90 hips in 76 patients with ONFH (Ficat stage I to II) after a mean follow-up of 35.3 months. All patients received standard radiographs including an anteroposterior (AP) and a FL view of the affected hip. The percentage of the necrotic area (necrotic area/whole femoral head area) was measured and compared between AP and FL view. Hips with ONFH were categorized using the JIC classification and the FL view type system, and inter-and intraobserver reliability was compared between them. All patients underwent personalized hip physiotherapy, and the cumulative survival rate with subsequent collapse and/or requirement for further hip surgery as the endpoints was evaluated for the two classification systems. The percentage of the necrotic area was found to be significantly greater in the FL views (47.0 ± 1.5%) than that in the AP views (37.7 ± 1.7%, P < .01).Intraobserver reliability in the JIC classification (mean: 0.91, range: 0.85-0.98) was higher than that in the FL view type (mean: 0.77, range: 0.63-0.89; P < .01), as well as the interobserver reliability in the JIC classification (mean: 0.74, range: 0.38-0.87) was higher than that in the FL view type (mean: 0.58, range: 0.31-0.76; P < .01).Comparisons of survival curves showed that type III in FL view type had the worst prognosis than other two divisions, following the type II. The type I was likely to gain optimal outcomes. These findings provide evidence that the location to which necrosis extended in the FL view is a reliable indicator in predicting the prognosis of ONFH.

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Does Lesion Size Affect the Outcome in Avascular Necrosis?

Cited by 132 publications

References 21 publications

Cost-effectiveness Analysis of Core Decompression

Cost-effectiveness Analysis of Core Decompression

Avascular Necrosis of Femoral Head Treated by Total Hip Replacement in AIDS Patients - A Case Report -

Frog leg lateral view is a reliable predictor of the prognosis in osteonecrosis of the femoral head

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