Efficacy of core decompression plus bone graft with minimal incision in 41 patients with osteonecrosis of the femoral head

Abstract

Aim: In this study, which is an experimental before‐after‐study, we evaluated the efficacy of core decompression in 56 hips of 41 patients with non‐traumatic osteonecrosis of the femoral head. Method: Fifteen (36%) patients were male and 26 (64%) were female. The mean age of patients was 30 years. Thirty‐six (88%) patients had long‐term histories of steroidal use. Thirty‐three (80%) patients had a history of underlying disease. The mean duration of follow‐up was 55 months (14–122 months). Results: According to Ficat classification, seven hips were in stage 1, 21 in stage 2A, 23 in stage 2B, and five in stage 3. Evaluation criteria according to Harris hip score (HHS), radiographic changes and total hip arthroplasty (THA) necessity were assessed in each stage. The result of core decompression and graft was remarkable compared with preoperation status. HHS increased from 82 to 91 in stage 1; 73 to 89 in stage 2A; 70 to 85 in stage 2B and 63 to 71 in stage 3 post‐operatively (P‐value < 0.05). Discussion: In the last follow‐up, which the was same for all 41 patients, there was no need for THA in all cases; but 5/56 hips (9%) exhibited radiographic progression of at least one Ficat stage. This method did not have any major complications, as only three cases had superficial wound infection. Conclusion: Good and safe clinical results of this method and the availability of this surgical treatment and also early return of patients to ordinary activities make us satisfied with applying this method.

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

“…Numerous procedures have been proposed to treat this condition, including core decompression [1,6,18,19,24,29,47,49,58,63], vascularized grafts [3,5,7,8,20,27,28,30,39,50,61,66], and osteotomy [2,9,16,17,23,40,44,45,62]. The term ''core decompression'' represents a spectrum of procedures that may include one large core tract or multiple small tracts [25,32].…”