An all-arthroscopic light bulb technique to treat osteonecrosis of the femoral head through outside-in fashion without distraction: A case report

Abstract

The technique of distraction has been widely used in hip arthroscopy for opening joint spaces. However, an all-arthroscopic light bulb technique through outside-in fashion without distraction has not been reported for the treatment of osteonecrosis of the femoral head (ONFH). A 29-year-old man was admitted to our department with hip pain and limited range of motion (ROM) in both hips over 4 months. X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) showed a mixed appearance, including sclerosis and cysts on the anterosuperior site of the bilateral femoral heads. The patient had an 11-year history of liquor intake. In addition, no other pathologies were found before the operation. After diagnosing bilateral ONFH (stage II) according to the Ficat classification, the patient underwent an all-arthroscopic light bulb technique through outside-in fashion without distraction because of failing conservative treatment. At the 2-year postoperative follow-up, the patient had neither pain nor limitation of ROM. The postoperative x-ray, CT, and MRI revealed a well-healed area of the previous bone grafting in the bilateral femoral heads. An all-arthroscopic light bulb technique through outside-in fashion without distraction can be a feasible method for the treatment of early-stage ONFH. This case reminds us that distraction- and perforation-related complications may be avoided in patients with ONFH without the concomitant pathologies of the central compartment.

Hip Arthroscopy Debridement Combined with Multiple Small‐Diameter Fan‐Shaped Low‐Speed Drilling Decompression in the Treatment of Early and Middle Stage Osteonecrosis of the Femoral Head: 14 Years Follow‐Up

“…In a prospective study comparing the accuracy of MRI and diagnostic arthroscopy in staging ONFH, 36% of femoral head collapse and cartilage lesions in 52 hip patients were not detected by MRI, while hip arthroscopy achieved accurate diagnoses and staging of necrotic conditions. In the early stages of this disease, MSFLD combined with hip arthroscopic debridement can observe intra‐articular lesions; incise the anterior joint capsule to reduce intra‐articular pressure; clean up proliferative synovium, trim cartilage, and remove inflammatory substances, effectively reducing pain, improving efficacy, and prolonging femoral head survival 25–27 . Ashberg et al 28 found that joint cartilage damage accelerates joint degeneration, significantly reduces Harris scores, and doubles the THA conversion rate compared to the control group.…”

“…In the early stages of this disease, MSFLD combined with hip arthroscopic debridement can observe intra‐articular lesions; incise the anterior joint capsule to reduce intra‐articular pressure; clean up proliferative synovium, trim cartilage, and remove inflammatory substances, effectively reducing pain, improving efficacy, and prolonging femoral head survival. 25 , 26 , 27 Ashberg et al 28 found that joint cartilage damage accelerates joint degeneration, significantly reduces Harris scores, and doubles the THA conversion rate compared to the control group. Arriaza et al 29 treated patients with ONFH and cartilage injuries with hip arthroscopic surgery, and after repairing the articular cartilage, 85% of patients experienced significant pain relief.…”