Two-year follow-up after advanced core decompression

Claßen, Tim; Warwas, Sebastian; Jäger, Markus; Landgraeber, Stefan

doi:10.1002/term.2056

Cited by 30 publications

(18 citation statements)

References 27 publications

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“…It also classifies femoral head necrosis according to its corresponding acetabulum weight-bearing area as A, B, C1, and C2 types. Classen et al [ 21 ] adapted advanced core decompression surgery to treat osteonecrosis of the femoral head, and they reported that defect type C had a significantly higher rate of femoral head collapse than the smaller defects sizes A and B. Lieberman et al [ 8 ] systematically reviewed 5 reports on the correlation between necrosis location and clinical failure rates. The results suggest that when the femoral head necrotic area did not exceed the corresponding inner weight-bearing area by 30%, only one out of 22 cases (4.5%) was a clinical failure, while when the femoral head necrosis area exceeded the corresponding inner weight-bearing area by 60%, 41 out of 91 cases (45%) were clinical failures.…”

Section: Discussionmentioning

confidence: 99%

Investigating Clinical Failure of Bone Grafting through a Window at the Femoral Head Neck Junction Surgery for the Treatment of Osteonecrosis of the Femoral Head

et al. 2016

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AimsThis study aimed to analyze the clinical factors related to the failure of bone grafting through a window at the femoral head-neck junction.MethodsIn total, 119 patients (158 hips) underwent bone grafting for treatment of avascular necrosis of the femoral head. The patients were classified by their ARCO staging and CJFH classification. All patients were clinically and radiographically followed up every three months during the first year and every six months in the following year. The clinical follow-up comprised determination of pre- and postoperative Harris hip scores, while serial AP, frog lateral radiographs, and CT scan were used for the radiographic follow-up.ResultsThe clinical failure of bone grafting was observed in 40 patients. The clinical failure rates in patients belonging to ARCO stage II period, IIIa, and III (b + c) were 25.9%, 16.2%, and 61.5%, respectively, while those in patients belonging to (C + M + L1) type and L2, L3 type disease groups were 1.7%, 38.9%, and 39%, respectively. The clinical failure rates in patients aged below 40 and those aged 40 and over were 20.5% and 39.0%, respectively (all P < 0.05).ConclusionDisease type, disease stage, and patient age are risk factors for failure of bone graft surgery. Patients belonging to ARCO stage II and IIIa showed a good overall response rate, while patients belonging to ARCO stage IIIb and IIIc and those with necrotic lesions involving the lateral pillar (L2 and L3 type) showed high surgical failure rates.

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Section: Discussionmentioning

confidence: 99%

Investigating Clinical Failure of Bone Grafting through a Window at the Femoral Head Neck Junction Surgery for the Treatment of Osteonecrosis of the Femoral Head

et al. 2016

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“…Previous studies have shown the effect of certain parameters on the long-term outcome of ONFH therapy. These known parameters include lesion stage and lesion size as well as the presence of risk factors and concomitant hip pathologies [3,21,22].…”

Section: Discussionmentioning

confidence: 99%

“…The secondary endpoint was set as the evidence of age-or sex-dependent differences in joint As it is known that the treatment outcome of ONFH depends on several co-factors, the subgroups were further analysed regarding the presence and distribution of possible confounders. The parameters recorded in this context include the size of the necrotic lesion (A-C according the ARCO and Steinberg classifications), the presence of risk factors (immunosuppressive therapy, high-dose corticosteroid treatment, abuse of alcohol and nicotine and coagulation disorders) and radiological evidence of cam-type deformity of the affected hip using the alpha angle according to Nötzli [21,22,28,29].…”

Section: Methodsmentioning

confidence: 99%

“…Treatment of advanced ONFH stages as described in the ARCO and Steinberg classifications is more likely to fail than treatment of early ones [3,[18][19][20]. Lesion size also seems to have a significant effect on outcome, with larger lesions often resulting in joint-line collapse despite surgery [21]. Concomitant pathologies of the hip joint such as the femoroacetabular impingement syndrome seem to reduce the rate of therapy success in ONFH even further [22].…”

Section: Introductionmentioning

confidence: 99%

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Results of advanced core decompression in patients with osteonecrosis of the femoral head depending on age and sex—a prospective cohort study

et al. 2020

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Background: Core decompression is a common surgical technique to treat osteonecrosis of the femoral head. The aim of this study is to evaluate the effect of the parameters "age" and "sex" on the outcome of this type of treatment. Methods: A prospective cohort study was performed. Eighty-six osteonecrotic hips with a mean follow-up of 32.5 months (± 24.8) after advanced core decompression were analysed regarding age-and sex-dependent treatment failure. Additionally, the modified Harris Hip Score and Numeric Rating Scale were compared regarding the parameters age and sex. Results: The mean hip survival of the male participants was 51.3 months (39.4% treatment failure), whereas females presented a longer, thus not significant, mean survival of 61.4 months (30% therapy failure; p = 0.48). The further evaluation revealed significantly better survival in the patients aged < 40 years (mean survival 66.09 months, 16% treatment failure) in comparison to those aged ≥ 40 years (mean survival 50.14 months, 46% therapy failure; p = 0.03). The modified Harris Hip Score and Numeric Rating Scale results of patients whose treatment did not fail during the study period were similar, irrespective of the patient's sex or age. Conclusions: The study shows that the number of therapy failures is significantly higher in older patients, with 40 years of age marking the borderline. Patients' sex does not seem to affect the outcome of treatment, and postoperative clinical scores appear to be identical with individuals not affected by therapy failure. Since age and sex are unalterable parameters, the study helps to provide valuable predictions regarding the chances of long-term hip survival after treatment of osteonecrosis.

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“…Furthermore, we know that the success of ONFH therapy depends to a large extent on the stage of the disease and the size of the lesions. Stages beyond ARCO 2 and Steinberg 2, as well as Type C lesions, clearly show a worse outcome regardless of the type of therapy performed (Classen, Warwas, Jäger, & Landgraeber, ; Mont, Jones, & Hungerford, ). The present study indicates that the alpha angle and the head–neck offset are possible (co)factors that influence therapy outcome in ONFH patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head

Serong

Haversath

Jäger

et al. 2019

J Tissue Eng Regen Med

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Osteonecrosis of the femoral head (ONFH) and CAM-type femoroacetabular impingement (FAI) present two different pathologies of the hip joint. The aim of this study is to describe the prevalence of CAM-FAI in a collective of ONFH hips and to evaluate its influence on ONFH therapy outcome. A cohort of 86 ONFH hips with a mean follow-up of 46.7 months (±20.5) after advanced core decompression (ACD) was evaluated regarding CAM deformity by measuring the alpha angle (α) and headneck offset. The influence of CAM-type FAI was investigated using the Kaplan-Meier estimator and the Cox regression model. The mean α was 60.4°(±13.8) with 41 hips (47.7%) being ≥60°. The mean head-neck offset was 4.5 mm (±3.2), with 78 hips (90.7%) being ≤9 mm. Survival analysis indicated noticeably better ACD results for α < 60°versus α ≥ 60°(p = 0.07). Treatment failure within the first 2 years was statistically estimated as 27.7% for α < 60°versus 40.7% for α ≥ 60°: The hazard ratio for α ≥ 60°was 1.94. Head-neck offset-dependent survival showed better, though not significant, results for offset >9 mm (p = 0.38, hazard ratio 1.89 for offsets ≤9 mm). The prevalence of CAM-type deformity is greatly increased in patients with concomitant ONFH. There is a strong indication that CAM-type FAI has a negative influence on ONFH therapy outcome. The risk that ONFH treatment will fail seems to be twice as high for α ≥ 60°as for α < 60°. We recommend cotreatment of pathological head-neck offset in patients with ONFH.

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Two-year follow-up after advanced core decompression

Cited by 30 publications

References 27 publications

Investigating Clinical Failure of Bone Grafting through a Window at the Femoral Head Neck Junction Surgery for the Treatment of Osteonecrosis of the Femoral Head

Investigating Clinical Failure of Bone Grafting through a Window at the Femoral Head Neck Junction Surgery for the Treatment of Osteonecrosis of the Femoral Head

Results of advanced core decompression in patients with osteonecrosis of the femoral head depending on age and sex—a prospective cohort study

Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head

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