Ischemic necrosis of the femoral head. Treatment by core decompression.

Hopson, Clark N.; Siverhus, S. W.

doi:10.2106/00004623-198870070-00013

Cited by 93 publications

(29 citation statements)

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“…In our series of CD, overall success rates for hips in Steinberg stages 0-II are 82% after 2 years, 57% after 4 and 50% after 6 years. Although the follow-up periods are different, these figures are comparable to those reported by Powell et al [23] and Warner et al [31], better than those reported by Camp et al [1], Hobson et al [8], Learmonth et al [16], Markel et al [18], Kristensen et al [15], but worse than those reported by Fairbank et al [3], Lederer and Knahr [17] and Smith et al [25].…”

Section: Discussionsupporting

confidence: 71%

“…During the first 6 years we observed deterioration in all subgroups of our study population. Some of the disparity in the results following CD might be explained by the fact that most of the published studies do not use survivorship analysis and life tables when describing their results [8,[16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Core decompression (CD) is a treatment option that has been in use since the 1960s [4,10]. Although widely used, published clinical results are inconsistent and range from disappointing [1,8,14] to encouraging [3,25,27].This study was undertaken to evaluate the postoperative success of CD as judged by the need for re-operation, radiographic progression and clinical outcome, by using survivorship analysis. …”

mentioning

confidence: 99%

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Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

Simank

Brocai

Strauch

et al. 1999

International Orthopaedics

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The results of core decompression of the femoral head in the treatment of osteonecrosis are analyzed. This study includes 94 hips in 74 patients with a followup time ranging between 18 months and 15 years (average 6 years). There had been no need for further surgery 2 years postoperatively in 85% of the hips with preoperative Steinberg stages 0, I and II when compared with 66% with preoperative stages III, IV and V. At 4 years postoperatively the corresponding figures are 73 compared to 55%; and 6 years postoperatively 69 compared to 49%. This difference was significant (P=0.0402). Further significant risk factors are corticosteroid administration, smoking and alcohol intake. The results of core decompression are good when the preoperative lesion is at Steinberg stage 0, I and II and the patient does not present with other risk factors. In cases with risk factors the outcome is significantly less good. The procedure is not indicated in the presence of advanced disease.Résumé Dans cette étude nous avons analysé les résul-tats de la décompression de la tête fémorale chez des patients avec ostéonécrose de la tête du fémur. 94 hanches de 74 patients ont été analysées. La durée de suivi a varié entre 18 mois et 15 ans. Deux ans après la décom-pression les résultats ont été satisfaisants (aucune reintervention chirurgicale) dans 85% des cas avec une nécrose préoperatoire dans les stades de Steinberg 0, I ou II. Avec les stades III, IV ou V les résultats ont été satisfaisant dans 66% des cas. Quatre ans après la décompres-sion les résultats satisfaisant ont été 73% (0, I ou II) et 55% (III, IV ou V). Six ans après la décompression les résultats satisfaisant ont été 69% et 49%. Les traitements avec corticoide, l'alccol et la nicotine augmentent le risque d'une ré intervention chirurgicale après la decompression d'une maniére significative. Les résultats de la decompréssion sont bons, si la 1ésion de la nécrose n'excéde pas le stade II de Steinberg et s'il n'a pas autres facteurs risque. Avec des facteurs de risque les résultats dé-clinent significativement. Dans les stades de Steinberg III, IV ou V la décompression n'est pas indiquée. IntroductionOsteonecrosis of the femoral head (ONFH) is a disease of unknown pathology. The natural history normally progresses to femoral head arthrosis with the need for total hip replacement (THR) [4]. Nonoperative treatment, such as limited weight-bearing, has been shown to be of little value. About 80% of conservatively treated patients require THR [21]. Core decompression (CD) is a treatment option that has been in use since the 1960s [4,10]. Although widely used, published clinical results are inconsistent and range from disappointing [1,8,14] to encouraging [3,25,27].This study was undertaken to evaluate the postoperative success of CD as judged by the need for re-operation, radiographic progression and clinical outcome, by using survivorship analysis. Patients and methodsIn 1997 we performed a retrospective study of patients who had undergone a CD procedure as treatment fo...

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

Simank

Brocai

Strauch

et al. 1999

International Orthopaedics

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“…In a systematic literature review, Marker et al [12] evaluated the clinical and radiographic outcomes of core decompression in surgeries done before [13][14][15][16][17][18][19][20][21][22] and after 1992 [1,2,10,[23][24][25][26][27][28][29][30][31] (n=1268 and 1337 hips, respectively). The authors demonstrated that in procedures performed before 1992, 41 % of hips required additional surgery after a mean follow-up of 65 months (range, 3 to 216 months).…”

Section: Overall Outcomes Of Traditional Core Decompressionmentioning

confidence: 99%

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

Pierce

Jauregui

Elmallah

et al. 2015

Curr Rev Musculoskelet Med

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The review describes the following: (1) how traditional core decompression is performed, (2) adjunctive treatments, (3) multiple percutaneous drilling technique, and (4) the overall outcomes of these procedures. Core decompression has optimal outcomes when used in the earliest, precollapse disease stages. More recent studies have reported excellent outcomes with percutaneous drilling. Furthermore, adjunct treatment methods combining core decompression with growth factors, bone morphogenic proteins, stem cells, and bone grafting have demonstrated positive results; however, larger randomized trial is needed to evaluate their overall efficacy.

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“…Most available treatments for osteonecrosis of the femoral head aim to forestall collapse of the subchondral bone, either by directly reducing stresses in vulnerable repairing bone (reduced weight bearing [28], rotational osteotomies [2,27,43,48], vascularized bone grafting [22,44,50]), or by enhancing natural structural repair processes (core decompression [ 12,131, electromagnetic stimulation [ 1,471 and bone grafting techniques [29,30]). Despite recent diagnostic advances, however, effective treatments have been elusive, with a preponderance of cases ultimately resulting in collapse.…”

Section: Introductionmentioning

confidence: 99%

A new animal model of femoral head osteonecrosis: one that progresses to human‐like mechanical failure

Conzemius

Brown

Zhang

et al. 2002

Journal Orthopaedic Research

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Existing animal models of femoral head osteonecrosis, while displaying varying levels of concordance with early histopathologic features of the human disorder, generally fail to progress to end-stage mechanical collapse. A new animal model of osteonecrosis is here introduced, utilizing the emu (Drornaius nouaehollandie). These animals' bipedality and their high activity level represent a much more challenging biomechanical environment to the hip than seen in quadrupedal models of this disorder. Femoral head osteonecrosis was induced surgically, using a combination of ischemic (vessel ligation) and cryogenic (liquid nitrogen) insults. Of nineteen emus allowed free-roaming pen activity to study the natural history of such lesions, eighteen progressed to an osseous structural failure, sixteen of them developing incapacitating lameness at an average time point 11.75 weeks after the surgical insult. Histologically, the animals showed close concordance with both the early-and late-stage human pathology, in six cases even to the point of developing a crescent sign. Because of its large physical size and its consistent progression to mechanical collapse, the emu appears to offer a unique opportunity for the near-human-scale study of surgical interventions to forestall femoral head collapse. Toward this end, various directions for model refinement are outlined.

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Ischemic necrosis of the femoral head. Treatment by core decompression.

Cited by 93 publications

References 0 publications

Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis

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

A new animal model of femoral head osteonecrosis: one that progresses to human‐like mechanical failure

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