Comparative Assessment of Surgical Treatment Results of Patients with Early-Stage Avascular Necrosis of the Femoral Head

Abstract

Objective. To conduct a comparative evaluation of the results of surgical treatment of patients with early stage osteonecrosis of the femoral head using different methods of core decompression and autologous bone grafting of the femoral head.
 Material and methods. A comparative analysis of the results of treatment of patients with early stages of ONFH was carried out. The patients were divided according to the method of treatment into two groups: control and main. In the control group (n=19), surgical treatment was performed using open decompression and autologous bone grafting of the femoral head using the Rosenwasser M.R. technique "light bulb". The main group (n=17) included patients whose surgical treatment was performed using the developed method of combined impaction autoplasty of the femoral head (RF patent for invention No. 2583577 dated April 13, 2016). Clinical and functional evolution of treatment results was performed using the Harris Hip Score (HHS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Evaluation was performed preoperatively and at 3, 6, and 12 months postoperatively.
 Results. The comparative analysis showed a significant difference in clinical and functional results after surgical treatment in patients of the control and main groups: patients of the main group demonstrated the best results at all periods of observation, however, their most pronounced difference was noted at a follow-up period of 6 months after surgery, with further preservation of this trend up to 12 months after surgery.
 Conclusion. A comparative evaluation of the effectiveness of open core decompression with bone autoplasty of the femoral head defect using the “light bulb” method and closed intralesional resection of the necrosis focus with combined impaction plastic of the femoral head revealed that minimal trauma to the para- and intra-articular tissues when accessing the area of the pathological focus and carrying out the main stages of the operation allows you to achieve the best clinical and functional results and create the most optimal conditions for remodeling processes in the osteoplasty area.