Efficacy of necrosis decompression techniques in the treatment of early stages of avascular necrosis of the femoral head

Abstract

BACKGROUND: There is no consensus on the methods of surgical treatment of early stages of avascular necrosis (AVN) of the femoral head. Decompression of the necrotic zone in different variations is the most widely used, but the effectiveness of it is debated.
 AIM: We evaluated the effectiveness of classic decompression of the necrotic zone and decompression using a percutaneous expandable reamer combined with bone graft.
 MATERIAL AND METHODS: Fifty patients were included in our study. The inclusion criteria were decompression of the necrotic zone in AVN of the femoral head at stages III and the possibility of assessing the effectiveness of surgical treatment after 12 months. Depending on the method of decompression, the patients were divided into two groups. Group 1 included 25 patients who underwent decompression using a percutaneous expandable reamer combined with bone graft. Group 2 consisted of patients who underwent classic decompression of the necrosis area. The groups were comparable in all major clinical characteristics. The efficacy of surgical interventions was assessed after 12 months by comparing pre- and postoperative assessment of the functional state of the hip joint using the Harris Hip Score and the intensity of pain syndrome using the visual analog score (VAS). The main criterion for ineffectiveness of AVN decompression of the femoral head was the need for total hip arthroplasty.
 RESULTS: Twelve months after surgical treatment of femoral head AVN, group 1 patients average Harris Hip Score was 63.9, group 2 patients average Harris Hip Score was 74.1 (versus 59.1 and 63.9 before surgery, respectively); VAS was 2.7 in both groups (versus 5.5 and 4.8 before surgery, respectively). Three patients (12%) from group 1 and four patients (16%) from group 2 underwent total hip arthroplasty, to persisting pain syndrome and progression of osteonecrosis of the femoral head to the subchondral fracture stage. The differences between the groups were statistically insignificant.
 CONCLUSION: Decompression of the necrosis zone is an effective method of treatment of stages I and II of AVN of the femoral head, significantly reducing the intensity of pain syndrome and slightly improving the functional characteristics of the hip joint. Studies in this direction should be continued with the involvement of more profiled patients and with the analysis of the effectiveness of other joint-preserving surgical techniques.