Management of avascular necrosis of femoral head at pre-collapse stage

Sen, Ramesh Kumar

doi:10.4103/0019-5413.45318

Cited by 108 publications

(104 citation statements)

References 71 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…Magnetic resonance imaging could have performed to detect avascular necrosis of the femoral head, but would not have changed the treatment modalities, as avascular necrosis of the femoral head was not contraindicated for either procedures we were undertaking. 22 Osteoporosis is a contributing factor leading to implant failure. Bone densitometry should be performed to avoid internal fixation for osteoporotic patients.…”

Section: Discussionmentioning

confidence: 99%

Neglected Femoral Neck Fractures in Adults

Kainth

Yuvarajan

Maini

et al. 2011

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Purpose. To assess treatment outcomes in adults with neglected femoral neck fractures, and propose a treatment protocol based on bone quality measured by the Singh index. Methods. 16 men and 6 women aged 18 to 48 (mean, 33) years presented with neglected (>3 weeks old) femoral neck fractures. Those with good bone quality (Singh index, >3) underwent closed reduction and valgus osteotomy and fixation with 120º double angle blade plates (group 1, n=8), whereas those with poor bone quality (Singh index, <3) and/or communition of the posterior femoral neck underwent fibular grafting and internal fixation with one or two 7-mm cannulated cancellous screws (group 2, n=14). Functional outcome was assessed at the 6-month follow-up, according to modified Askin and Bryan criteria. 2011;19(1):13-7 4-21) weeks. Patients were followed up for a mean of 19 (range, 12-24) months. The mean time to union was 20 (range, 12-52) weeks. The mean time to full weight bearing was 18 (range, 12-40) weeks. All patients achieved bone union except one in group 1 who had non-union and breakage of the blade plate at week 20 and underwent total hip arthroplasty. Other complications included slippage of fibular graft (n=1), delayed union (n=1), avascular necrosis of the femoral head (n=2, Fig. 6), limb length discrepancy (n=3), and superficial infection (n=1). Functional outcome was excellent in 2 patients, good in 17, and poor in 3. Conclusion. Valgus osteotomy and double angle blade plate fixation, and fibular grafting and cancellous screw fixation appeared to be appropriate treatments for neglected femoral neck fractures in adults. Journal of Orthopaedic Surgery

show abstract

Section: Discussionmentioning

confidence: 99%

Neglected Femoral Neck Fractures in Adults

Kainth

Yuvarajan

Maini

et al. 2011

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

show abstract

“…More difficult aspect is to assess the burden on our health resources. As India has mandated itself for-Health for allǁ by 2020 under guidance of WHO, it is important that potentially treatable, without which equally crippling Avascular necrosis of the femoral head be studied scientifically in Indian context, within the constraints of limited resources of our country [10] . In this background, present study, intends to carry out original research in a tertiary care hospital in southern India, by analyzing clinical and functional outcome in cases of avascular necrosis of femoral head treated surgically with Total Hip Replacement.…”

Section: Introductionmentioning

confidence: 99%

Study of clinical and functional outcome of total hip replacement in avascular necrosis of femoral head

Reddy¹,

Ms²,

Phad³

2018

Int. J. Orthop. Sci.

View full text Add to dashboard Cite

Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Since young age is associated with high functional demand AVN may have a devastating effect on the quality of life. The natural course of this disease is one of relentless progression with eventual collapse of the femoral head followed by secondary osteoarthritic changes in the hip. The management depends upon many factors including severity and location of necrotic lesion, patient factors and probability of collapse. Total hip replacement (THR) is needed in cases of collapse of femoral head, severe pain, osteoarthritis or destruction of hip joint. However there has been debate over whether THR is a viable option for AVN considering unique pathophysiology of AVN. Moreover the factors like functional outcome after surgery implant longevity and need for revision surgeries must be considered while doing total hip arthroplasty. In this context we conducted this prospective observational study to find out the clinical and functional outcomes of THR in patients with of AVN. Aims and Objectives: To study the clinical and functional outcome of total hip replacement in avascular necrosis of femoral head. Material and methods: Patients admitted to department of orthopedics in a tertiary care hospital in a metropolitan city with diagnosis of AVN were included in the study after taking into consideration a predefined inclusion and exclusion criteria for the study. Sample size of 30 was considered following statistical formula and admission registry of our hospital. Patients were recruited to the study after approval from institutional ethical committee and informed consent of patients. A detailed history was taken and thorough clinical examination was done in all patients. All patients were assessed with Harris hip score and points were allocated for each components of the score, which formed base line statistics for our study. Further patients were followed up at 6 weeks, 12 weeks and 24 weeks. Patients who could not turn up to the hospital were contacted over telephone and outcome was assessed through set of questionnaire based on Harris hip score. Result: The study consisted of 30 patients diagnosed to be having avascular necrosis of head of femur. Out of these 30 patients 23 were males and 7 patients were females with a M: F ratio of 1: 0.30. The most common age group affected was 21-40 years (43.33%) followed by 41-60 years (33.33%) and 61-80 years (23.33%). Majority of the patients with AVN had a body mass index between 25 to 29.99 (36.67%). Co-morbidities like diabetes or hypertension were seen in 11 (36.67%) patients. 9 (30%) patients were having history of either alcohol consumption or smoking. 13 patients had some predisposing factor for AVN in the form of either alcohol consumption, steroid therapy, history of trauma or pregnancy and rest of the patients were found to be having idiopathic AVN. The most common presenting complaints in the studied cases were found to be pain and difficulty in walking (9...

show abstract

“…Evidence from a meta-analysis including over 800 hips shows that 76 % of hips treated solely with restrictive weight-bearing required an arthroplasty or salvage procedure [10]. The results from this and similar studies show universal agreement that restrictive weight-bearing as sole treatment is inappropriate [11]. Operative management is largely determined by the stage of the lesion, with femoral head collapse being the most important factor in management.…”

Section: Managementmentioning

confidence: 55%

Surgical Technique: Free Vascularized Fibular Graft for AVN

Mather¹,

Federer²,

Ruch³

2014

Hip Arthroscopy and Hip Joint Preservation Surgery

View full text Add to dashboard Cite

Avascular necrosis (AVN) or osteonecrosis of the femoral head (ONFH) is a common cause of hip pain and disability in a young patient demographic with an average age of mid-30s. If left untreated, approximately 80 % of cases of ONFH will result in femoral head collapse and hip degeneration necessitating total hip arthroplasty (THA) in a mean of 2 years. The relatively poor outcomes and requisite lifestyle changes associated with THA in this patient population have challenged surgeons to seek alternative treatment options. Vascularized bone grafts have been shown to have better radiographical and clinical results compared to nonvascularized bone grafts. Of these options, free vascularized fibular graft (FVFG) is the treatment of choice for its structural and vascular support within the femoral head. Improved technique has led to complication rates, including donor-site morbidity, statistically similar to that of nonvascular fibular grafts. When used in young patients with precollapse ONFH, FVFG can greatly improve patient outcome, with lower rates of conversion to THA than other treatment modalities.

show abstract

Management of avascular necrosis of femoral head at pre-collapse stage

Cited by 108 publications

References 71 publications

Neglected Femoral Neck Fractures in Adults

Neglected Femoral Neck Fractures in Adults

Study of clinical and functional outcome of total hip replacement in avascular necrosis of femoral head

Surgical Technique: Free Vascularized Fibular Graft for AVN

Contact Info

Product

Resources

About