Joint Preservation Trends in the Treatment of Osteonecrosis of the Femoral Head

Abstract

Osteonecrosis of the femoral head (ONFH) is problematic because multiple treatment options such as hip joint preservation procedures have been suggested, yet the best treatment for various stages of the disease remains controversial. The purpose of this study was to characterize the trends for hip joint preservation surgical procedures performed for ONFH in the United States between 2008 and 2014 to (1) assess the frequency and rates of surgical procedures for the treatment of femoral head osteonecrosis; (2) determine the frequency and rate of joint preservation procedures; and (3) determine the frequency and rate of hemiarthroplasty/femoral head resurfacing of this cohort. Using the American College of Surgeons National Surgical Quality Improvement Program, all patients who had a diagnosis of ONFH and underwent hip joint preservation surgery or hemiarthroplasty/femoral head resurfacing between the years 2008 and 2014 were identified. The hip joint preservation surgical procedures included bone grafting, core decompression, osteotomy, and arthroscopy. The annual frequency and rate of the various surgical procedures were collected. From 2008 to 2014, the annual number of all surgical procedures for ONFH increased from 88 to 1,161. While the number of core decompression procedures increased, the frequency of other joint preserving procedures stayed relatively the same. As a percentage of all surgical procedures, the percentage of all hip joint preservation procedures decreased from 17 to 3.3% (p?<?0.001). This corresponded to decreases in the percentage of bone grafting from 2.2 to 0.4%, core decompression from 12.5 to 2.8%, hip arthroscopy from 1.1 to 0.1%, and osteotomy from 1.1 to 0%. Over the same time period, the percentage of hemiarthroplasty/femoral head resurfacing decreased from 2.3 to 1.3%. The frequency and rate of surgical procedures for ONFH have increased over the years. However, the percentage of hip joint preservation procedures and hemiarthroplasty/femoral head resurfacing has decreased and makes up a smaller percentage of the total surgeries performed for treating ONFH.