Comparison of Different Core Decompression Techniques for Treatment of Early Stages of Osteonecrosis of the Femoral Head

Treatment of avascular necrosis of the femoral head is an issue of current interest while it affects young and employable people. So far there is no well-defined strategy of management which would help to postpone hip arthroplasty and further revision procedure. Hip sparing surgical treatment of avascular necrosis of the femoral head by bone grafting prior to head collapse proved to be a viable option not only during early stages of disease but also at advanced stages. platelet-rich plasma (pRp) addition to treatment plan potentially helps improving bone regeneration in situ. In this article the authors present a case of a 37 years old patient with avascular necrosis of the femoral head at a fragmentation stage (type 4B by aRcO). The authors centrifuged 15 ml of autologous whole blood (1500 RpM) obtained by a special double-contoured syringe. during the surgical stage of treatment pRp and morselized bone graft were mixed to introduce and impact into the debrided zone of avascular necrosis. The authors also introduced 0.3-0.4 ml of pRp into the debrided zone of avascular necrosis after bone grafting. at 6 months follow-up cT images of the studied patient demonstrated signs of bone reorganization and no loss of femoral head sphericity. preoperative Visual analogue Scale (VaS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) prior to treatment were 60, 45 and 33 points respectively. postoperative VaS, HHS and HOOS scores were 10, 78 and 78 respectively. In the authors' opinion, impaction bone grafting enhanced by pRp helps obtaining good and excellent outcomes not only at early but also at advanced stages of avascular necrosis.

Section: Introductionunclassified

Bone Grafting Enhanced by Platelet-Rich Plasma in Treatment of Avascular Necrosis of Femoral Head

Корыткин¹,

Зыкин²,

Zakharova³

et al. 2018

Osteonecrosis of the Femoral Head: Another Legacy of COVID-19?

Myasoedov,

Shubnyakov,

Sereda

et al. 2023

Background. Recovery from COVID-19 does not always proceed without complications, especially in patients who have suffered severe forms of the disease. Most researchers confirm a significant increase in the incidence of osteonecrosis of the femoral head (ONFH) after COVID-19. However, there is no clear opinion on the individual aspects of the development and course of the disease. This is an extremely important issue that allows us to identify the main risk groups for the development of post-COVID-19 osteonecrosis and, consequently, to perform the earliest possible screening of this complication. Aims of the study: 1) To evaluate the impact of the past COVID-19 on epidemiologic parameters and clinical course of osteonecrosis of the femoral head in patients; 2) to study the causes of its development. Methods. We have analyzed the data of medical histories of 674 patients diagnosed with osteonecrosis of the femoral head who sought medical care in 2018 and in 2022. Patients were divided into 4 groups according to the presumed causes of development of the disease. The first group enrolled 183 patients who underwent COVID-19 and received steroid therapy (ST). The second group included 78 patients who underwent COVID-19 without ST therapy. The third group consisted of 103 patients with ONFH that manifested in 2022 without COVID-19 in the previous medical history. The comparison group was made up of 310 patients who developed ONFH in 2018 before the appearance of the SARS-CoV-2 virus. Results. The sample of patients with COVID-19-associated osteonecrosis differed significantly from patients without COVID-19, in terms of gender, age, time of disease onset, extent of the femoral head damage, and disease progression rate (p0.001). The level of early ONFH diagnosis was extremely low, not differing from that in the pre-pandemic period. Conclusion. The COVID-19 pandemic has increased the incidence of ONFH, significantly modifying both its epidemiology and clinical picture. Nevertheless, the vigilance of practitioners remains extremely low, which affects the timely diagnosis of the disease.

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

Kotelnikov,

Kudashev,

Zuev-Ratnikov

et al. 2024

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.