Management of femoral head osteonecrosis: Current concepts

Trıpathy, Sujit Kumar; Goyal, Tarun; Sen, Ramesh Kumar

doi:10.4103/0019-5413.143911

Cited by 132 publications

(122 citation statements)

References 164 publications

(244 reference statements)

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“…It predisposes an individual for physical disability [5] . The social and economic cost associated with avascular necrosis of the femoral head can be significant for an individual [6] . Though, various treatment options have been tried in the past and few therapies are at current research stage (eg -Stem cell transplant), it is pertinent to state that definitive treatment of avascular necrosis of the femoral head is Total Hip Replacement as evidenced by empirical studies till date [7] .…”

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.

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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...

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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.

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“…Treatment options for femoral head osteonecrosis range from nonoperative modalities including restricted weight-bearing, pharmacological agents and biophysical modalities of treatment in early stages of the disease to operative modalities such as core decompression, non-vascularized and vascularized bone-grafting and arthroplasty in later stages [18,19] However, a report by Tripathy et al depicts that once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option [18]. The patient reported in this case report was diagnosed with Ficat and Arlet stage IV femoral head osteonecrosis with osteoarthritic joint space narrowing and degenerative changes and consequently had to benefit from total hip arthroplasty (THA) according to recommendations.…”

Section: Discussionmentioning

confidence: 99%

Severely Damaged Hip Joints from Avascular Necrosis in a patient with Sickle Cell Trait: Case Report

Efie¹,

Joseph²,

Yeika³

et al. 2017

J Blood Disord Transfus

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Background: Avascular necrosis of the femoral head is an increasingly recognized entity especially in the context of sickle cell disease. This entity is however less frequently seen in sickle cell trait; consequently, fewer cases of hip damage secondary to avascular necrosis in persons with sickle cell trait have been reported. This case shows how avascular necrosis can occur, affecting both hip joints in patients with sickle cell trait.

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“…There are non-operative treatments for ONFH, including restricted weight-bearing, bisphosphonates, anticoagulants, statins, extracorporeal shock wave therapy, pulsed electromagnetic therapy, and hyperbaric oxygen [6]. The goal of non-operative treatment of ONFH in early stage is to reduce pain, prevent depression in the femoral head, and improve function of the hip joint [3]. Long term effect of conservative treatments for ONFH has not been confirmed yet [4].…”

Section: Patients (Association Research Circulation Osseus Classificamentioning

confidence: 99%

“…Proposed risk factors of ONFH include corticosteroid use, alcohol consumption, trauma, and coagulation abnormality [2]. Because ONFH is a progressive disease, early diagnosis and proper treatment are important [3]. If untreated,…”

mentioning

confidence: 99%

Treatment of osteonecrosis of the femoral head by botulinum toxin type A injection to the psoas muscle -A case report-

Kim¹,

Lee²,

Kim³

et al. 2017

Anesth Pain Med

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Management of femoral head osteonecrosis: Current concepts

Cited by 132 publications

References 164 publications

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

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

Severely Damaged Hip Joints from Avascular Necrosis in a patient with Sickle Cell Trait: Case Report

Treatment of osteonecrosis of the femoral head by botulinum toxin type A injection to the psoas muscle -A case report-

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