Factors affecting the result of a conservative treatment in post-collapse osteonecrosis of the femoral head

Abstract

Osteonecrosis of the femoral head (ONFH) affects patients' quality of life. In our institute, some patients in the post-collapse state denied having an operation and considered continuing conservative treatment. Hence, the purpose of this study was to compare patient characteristics between patients who had total hip arthroplasty and those still on conservative treatment. We collected the data of seventy patients who had osteonecrosis of the femoral head with femoral head collapse from the hospital electronic database. All patients underwent the same approach in consideration of THA. We advised patients to shift to a THA treatment plan from a conservative one if the pain did not decrease by conservative treatment or improvement did not meet the patient's lifestyle and daily living requirements. We recorded the patient's demographic data, physical examination and hip radiographic. Twentynine patients (40 hips) had THA, while 31 patients (45 hips) were still undergoing conservative treatment. There were no differences in the patients' base demographic data. However, patients with THA had a lower rate of history of previous core decompression before head collapse than patients still undergoing conservative treatment (90.3% and 37.9%, respectively, p<0.01). In the conservative treatment group, most cases had femoral head collapse at the superolateral head, while patients in the THA group had an increased number of patients with collapse at the superomedial part of the femoral head. This study revealed that patients considering the continuation of conservative treatment had a higher rate of history of core decompression and a lower rate of supermedial femoral head collapse. Thus, these factors might be considered in the discussions with patients concerning the prognosis of the disease.