Aseptic Necrosis of the Femoral Head and Non-Union of the Femoral Neck

Bonfiglio, Michael; Yoke, Edward M.

doi:10.2106/00004623-196850010-00003

Cited by 79 publications

(10 citation statements)

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“…13 There have been many other reports evaluating individual methods of bone grafting for femoral neck nonunions that may be useful in patients with neglected fractures, failed fixation attempts, or well-aligned nonunions with osteonecrosis. 12,[14][15][16][17] However, the current literature does not support the superiority of any particular technique. 10 Osteotomies Historically, proximal femoral osteotomies have been used for the treatment of osteonecrosis-induced osteoarthritis, being first described by Barton in 1827.…”

Section: Bone Graftingmentioning

confidence: 99%

Salvage of Failed Hip Fracture Fixation

Angelini¹,

McKee²,

Waddell³

et al. 2009

Journal of Orthopaedic Trauma

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Nonunion of fractures about the femoral neck and intertrochanteric hip regions is uncommon. Patients who develop nonunions of these fractures typically exhibit marked pain and disability, thereby presenting a treatment challenge to the orthopaedic surgeon. Factors that guide the choice of salvage treatment include the anatomic site of the nonunion, the quality of the remaining proximal bone and articular surface, and patient factors (such as age and activity level). In the younger patients with a well-preserved hip joint, treatment typically involves revision internal fixation with or without osteotomy or bone grafting. However, in older patients, it is more common to encounter poor remaining proximal bone stock or a badly damaged hip joint from hardware cutout. As such, conversion to hip arthroplasty is intended to help effectively restore function and relieve pain. With respect to salvage procedures for the femoral head, the major challenges in decision making include the choice of both internal fixation device and accurate preoperative planning. The challenges involved in planning to convert to hip arthroplasty include the need for acetabular resurfacing, selecting the femoral implant, and managing discontinuity of the greater trochanter. Furthermore, there are additional technical challenges that may be encountered, such as broken hardware, deformity, and femoral bone defects. Overall, salvage of nonunions of femoral neck and intertrochanteric hip fractures in properly selected patients can provide patients with good to excellent results.

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Section: Bone Graftingmentioning

confidence: 99%

Salvage of Failed Hip Fracture Fixation

Angelini¹,

McKee²,

Waddell³

et al. 2009

Journal of Orthopaedic Trauma

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“…Initially, cemented total hip arthroplasty applications were used, but they are progressively being replaced by hybrid and cementless systems. 6 7 8…”

Section: Introductionmentioning

confidence: 99%

“…A princípio cimentadas, as artroplastias totais do quadril têm sido progressivamente substituídas por sistemas híbridos e não cimentados. 6 7 8…”

Section: Introductionunclassified

Efeito das posições dos enxertos na estabilidade da artroplastia total de quadril com diferentes tipos de encurtamento subtrocantérico

2019

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Resumo Objetivo O objetivo do presente estudo é investigar a estabilidade biomecânica de diferentes tipos de osteotomias subtrocantéricas e posições de enxertos em coxartroses displásicas que necessitam de artroplastia total de quadril com osteotomia de encurtamento, e determinar o tipo de osteotomia e a posição do enxerto que são mais eficazes. Método Modelos de fêmur (sawbones) foram usados para comparar os tipos de osteotomia de encurtamento femoral (transversal, oblíqua e em degrau de escada [step-cut]). Os enxertos em haste, preparados do lado da osteotomia subtrocantérica, foram fixados em diferentes posições (ântero-lateral, medial-lateral e ântero-posterior). A fixação dos enxertos foi feita com 2 cabos de aço (de 2,0 mm de largura) de mesma resistência. Os valores de falha dos fêmures compostos para cargas axiais e rotacionais foram registrados. Resultados Do ponto de vista biomecânico, não houve diferenças estatisticamente significativas entre os tipos de osteotomia de encurtamento subtrocantérico femoral e as posições dos enxertos em haste aplicados. Conclusão Não houve superioridade entre os tipos de osteotomia de encurtamento subtrocantérico femoral quanto à estabilidade. Além disso, em relação à resistência ao estresse, os resultados obtidos com diferentes posições das hastes foram similares. Assim, acreditamos que o método mais indicado é aquele em que o cirurgião é experiente e cuja aplicação é mais fácil.

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“…Once collapse has occurred in osteonecrosis of the femoral head (Ficat stage III [19]), the results of biological procedures, such as core decompression, have been poor either with [9,10,17,27] or without bone grafting [39]. Intertrochanteric osteotomies have produced variable results, especially when there were large necrotic lesions [21,30,41].…”

Section: Introductionmentioning

confidence: 99%

Endoprostheses for osteonecrosis of the femoral head

Grecula

Grigoris

Schmalzried

et al. 1995

International Orthopaedics

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Eighty-eight hip arthroplasties were carried out in 75 patients, all aged 50 years or less, with osteonecrosis. All the operations were carried out by one surgeon. Four different methods were used: a standard cemented arthroplasty; a cemented THARIES surface replacement; an uncemented surface replacement; a cemented titanium femoral surface hemiarthroplasty. Comparable clinical improvement occurred in all 4 groups initially. Aseptic loosening, with intersurface degradation and osteolytic lesions, was the most common cause of failure in the 3 types which had a polythene bearing. Polyethylene is the major contributor to bone loss around the endoprosthesis and loosening. Fixation of the surface hemiarthroplasty remained intact in every patient and failure was secondary to wear of the acetabular cartilage. We recommend surface hemiarthroplasty as an interim solution for young patients with stage III or early stage IV osteonecrosis because this procedure conserves bone stock, there is little osteolysis and it can easily be revised.

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Aseptic Necrosis of the Femoral Head and Non-Union of the Femoral Neck

Cited by 79 publications

References 0 publications

Salvage of Failed Hip Fracture Fixation

Salvage of Failed Hip Fracture Fixation

Efeito das posições dos enxertos na estabilidade da artroplastia total de quadril com diferentes tipos de encurtamento subtrocantérico

Endoprostheses for osteonecrosis of the femoral head

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