Management of Osteonecrosis of the Femoral Head

Plancher, Kevin D.; Razi, Afshin E.

doi:10.1016/s0030-5898(05)70302-3

Cited by 27 publications

(9 citation statements)

References 67 publications

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“…(), only 20% of patients were aged > 50 years at the time of their operation; 5–12% of hip replacements were performed for AVN and it has been estimated that 10 000–20 000 patients develop a new case of AVN every year in the USA (Mankin, ; Jacobs, ; Coventry et al ., ; National Center for Health Statistics, ; Robinson and Springer, ). The prevalence of bilateral AVN is more than 50 per cent (Hofmann et al ., ; Hofmann and Mazieres, ; Plancher and Razi, ; Schwartz Lausten, ). Currently, the aetiology and pathogenesis of AVN is not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Landgraeber

Theysohn

Claßen

et al. 2012

J Tissue Eng Regen Med

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Aseptic necrosis of the femoral head (AVN) leads to destruction of the affected hip joint, predominantly in younger patients. Advanced core decompression (ACD) is a new technique that may allow better removal of the necrotic tissue by using a new percutaneous expandable reamer. A further modification is the refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO₄)-calcium phosphate (CaPO₄) bone graft substitute. Compression tests were performed on seven pairs of femoral cadaver bones. One femur of each pair was treated with ACD, while the opposite side remained untreated. Clinically, the postoperative outcome of 27 hips in 23 patients was performed by physical examination 6 weeks after ACD and at average follow-up of 9.69 months, and compared with the preoperative results. MRI was used to assess the removal of the necrotic tissue, any possible progression of AVN and evaluation of collapse. In the biomechanical analysis, the applied maximum compression force that caused the fracture did not significantly differ from the untreated opposite side. The overall results of postoperative physical examinations were significantly better than preoperatively. Five hips (18.5%) were converted to a total hip replacement. The follow-up MRIs of the other patients showed no progression of the necrotic area. The first follow-up results of ACD have been encouraging for the early stages of aseptic necrosis of the femoral head. In our opinion, an assured advantage is the high stability of the femoral neck after ACD, which allows quick rehabilitation.

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Section: Introductionmentioning

confidence: 99%

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Landgraeber

Theysohn

Claßen

et al. 2012

J Tissue Eng Regen Med

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“…Treatment options include joint preserving procedures such as electrical stimulation, drilling, core decompression, vascularized or non-vascularized fibular grafting, and osteotomy; and joint replacement procedures such as resurfacing and hemi-or total hip arthroplasty (THA) [1, 2, 3, 11, 18, 28, 32, 34-36, 38, 41-44]. Early diagnosis and appropriate surgery may reduce the risk of progression and improve the outcome [6,12,18,19,21,24,29]. Among the joint-preserving surgical procedures, free vascularized fibular grafting (VFG) reportedly has a survival of 61%-96% at mid-term (4-7 years) followup [4,16,17,20,28,31,43,44].…”

Section: Introductionmentioning

confidence: 99%

Long-term Followup of Vascularized Fibular Grafting for Femoral Head Necrosis

Yoo

Kim

Hahn

et al. 2008

Clinical Orthopaedics &Amp; Related Research

104

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Vascularized fibular grafting has been used for treatment of osteonecrosis of the femoral head and although some reports demonstrate successful short- to mid-term outcomes, long-term results are still unknown. We retrospectively reviewed 135 patients (151 hips) who underwent vascularized fibular grafting for osteonecrosis of the femoral head. One-hundred and ten patients (124 hips) were followed for a minimum 10 years (mean, 13.9 years; range, 10-23.7 years). The mean Harris hip score improved from 72 to 88. At the latest followup, we found improved or unchanged radiographs in 37 of 59 hips initially Stage II hips and 39 of 65 Stage III hips. Thirteen hips (13 patients) (10.5%) failed treatment and underwent total hip arthroplasty. The location and size of the necrotic lesion and the patient's age influenced long-term survival of the graft. Postoperative complications included clawing of the big toe in 17 patients, partial peroneal nerve palsy in two, and superficial infection in two. Subtrochanteric fracture occurred in two hips. The data suggest free vascularized fibular grafting was successful in maintaining joint function and delaying the need for joint replacement procedure. Graft survival was associated with the patient's age and size and location of the lesion but not etiology and stages of the disease.

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“…In addition to core decompression therapy, there are also graft (vein-veinless fibula), mesenchymal stem cell, and tantalum rod applications. [15,16] Core decompression is still the preferred procedure because it is simpler than other methods, and the complication is low. The most common complication of this method is proximal femur fracture, which is reported to range between 0% and 18% [17] (Fig.…”

Section: Discussionmentioning

confidence: 99%

The Results Of Core Decompression Treatment In Femoral Head Avascular Necrosis

et al. 2018

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Objective: Avascular necrosis of the femoral head (AVNFH) is a progressive disease seen in young, active patients, leaving significant disability in the joint when untreated. We retrospectively examined the results of patients with early stage AVNFH who had been operated in our clinic. Methods: In our study, 65 hips of 46 patients were evaluated retrospectively. These patients were evaluated clinically by the Merle d'Aubigné-Postel Score and Harris Hip Score. The patients were radiologically staged according to the criteria by Ficat and Arlet with hip anterior-posterior and lateral graphs and magnetic resonance imaging. Results:The mean follow-up period of the patient group was 73 months, and the mean age of the patients was 35 years. Of these patients, 59% were female and 41% were male; 41% had bilateral and 40% had right hip involvement. One of the patients developed AVNFH while she was pregnant, 7 were idiopathic, and 38 (81%) developed AVNFH due to steroid use. According to the Ficat and Arlet classification, 18 hips were found to be stage 1, 37 hips stage 2, and 9 hips stage 3 during admission. From the etiological point of view, 81% of the patients developed AVNFH while using steroid and 19% had idiopathic AVNFH. As for clinical improvement of the patients, the Harris Hip Score increased from 58 to 90 in idiopathic patients and 55 to 83 among steroid users. The Merle d'Aubigné-Postel classification scores increased from 6 to 15 in the idiopathic group and from 6 to 13 among steroid users. Radiologically, according to the Ficat and Arlet stage, progression was seen in all stages. Of the patients, 38.8% in stage 1, 70.2% in stage 2, and 88.8% in stage 3 showed progression, whereas 20% demonstrated rapid progression and needed total hip prosthesis. All patients who demonstrated progression were on chronic steroid therapy. The mean time to conversion to total hip replacement was 27 months. Conclusion: Osteonecrosis is a disease associated with high morbidity. Early diagnosis can reduce morbidity and improve a patient's quality of life. Core decompression has the effect of stopping the progression of AVNFH in the early (stage 1) stages, although it has a significant and long-term palliative effect in all stages. Most of the young and active patients with AVNFH still do not have any ideal method for treatment today, but core decompression in the early stages has been seen to reduce morbidity. It is a time-saving attempt before the final treatment, which is hip arthroplasty, is performed.

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Management of Osteonecrosis of the Femoral Head

Cited by 27 publications

References 67 publications

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Advanced core decompression, a new treatment option of avascular necrosis of the femoral head - a first follow-up

Long-term Followup of Vascularized Fibular Grafting for Femoral Head Necrosis

The Results Of Core Decompression Treatment In Femoral Head Avascular Necrosis

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