Evaluation of core decompression for early osteonecrosis of the femoral head

Abstract

Twenty-six hips (19 patients) with osteonecrosis of the femoral head with stage I or II of the disease, according to the Ficat and Arlet classification, underwent core decompression. Osteonecrosis was confirmed histologically in all 26 hips. Of 19 patients, 7 had prognostic factors traditionally associated with poor outcome including collagen vascular disease and continued use of steroids. The follow-up period averaged 7 years 10 months (range: 2 years 5 months-13 years 8 months) for 17 patients with 24 hips. Two patients died secondary to systemic illness. Seventeen hips (65.4%) had very good or good results using the Ficat criteria. Eight hips (30.8%) needed further operation [total hip arthroplasty (THA) for 7 hips, osteotomy for 1 hip]. Of the 12 hips in patients who had used steroids, 6 hips (50%) were converted to THA. Four hips in patients with systemic lupus erythematosus (SLE) needed THA (100%). We conclude that core decompression provides an effective treatment for steroid-associated osteonecrosis other than in cases with SLE, as well as providing effective treatment for non-steroid-associated osteonecrosis in the early stages of the disease.

A current review of core decompression in the treatment of osteonecrosis of the femoral head

“…Similarly, Rajagopal et al [32•] assessed the efficacy of core decompression in a systematic literature review of four level IV studies (n=139 hips) [13,27,33,34]. After a minimum 2-year follow-up, approximately 26 % of all cases were converted to THA.…”

Which Factors Influence Preservation of the Osteonecrotic Femoral Head?

“…Numerous procedures have been proposed to treat this condition, including core decompression [1,6,18,19,24,29,47,49,58,63], vascularized grafts [3,5,7,8,20,27,28,30,39,50,61,66], and osteotomy [2,9,16,17,23,40,44,45,62]. The term ''core decompression'' represents a spectrum of procedures that may include one large core tract or multiple small tracts [25,32].…”

Treatment of osteonecrosis of the femoral head in lymphoma patients by free vascularised fibular grafting

“…It has demonstrated some success in treatment of hips without preoperative collapse, but it has been less successful for hips that had already collapsed [19]. Osteotomies are effective for hips with preoperative collapse, but these procedures are technically demanding and the successful results are difficult to reproduce [20].…”