Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study

Abstract

BackgroundMultiple small drilling for core decompression is widely used to preserve the femoral head in patients with avascular necrosis of the femoral head (ANFH). Nevertheless, the clinical outcome remains controversial. Simvastatin has been demonstrated to promote bone formation and reduce bone adsorption. The purpose of this study was to determine whether simvastatin enhanced the effect of multiple decompressions in preventing progression of ANFH and to identify independent risk factors associated with poor results.MethodsWe retrospectively analyzed 58 hips in 36 patients, with a follow-up of 36 months. 20 patients (32 hips) underwent multiple drilling combined with simvastatin treatment (SIM group); 16 patients (26 hips) underwent multiple drilling alone (MD group). We defined clinical failure as a requirement for subsequent hip surgery or Harris Hip Score < 75. New occurrence of collapse or increased collapse > 2 mm on plain radiographs was defined as radiological failure.ResultsSuccessful clinical results were achieved in 27 of 32 hips (84 %) in the SIM group compared with 15 of 26 hips (58 %) in the MD group (OR = 0.2, CI (0.1, 0.6.), P = 0.032). Successful radiological results were achieved in 27 of 32 hips (84 %) in the SIM group and in 16 of 26 hips (61.5 %) in the MD group (P = 0.048). Body mass index, disease stage and location of lesion were independent prognostic factors for overall survival.ConclusionsWe believe that simvastatin could enhance the effects of multiple decompressions in preventing progression of ANFH and reducing the risk of femoral head collapse.

Untargeted metabolomics reveals the effect of lovastatin on steroid-induced necrosis of the femoral head in rabbits

“…The use of statins in the treatment of steroid-induced necrosis of the femoral head has become popular in the past years [16,37]. As the clinical medicine, the statins have been proved that were useful in preventing steroid-induced necrosis of the femoral head in clinical treatment [15]. However, the key metabolic pathways and potential biomarkers were not clear.…”

“…Firstly, the pathways of glycerophospholipid metabolism, linoleic acid metabolism, sphingolipid metabolism, alpha-Linolenic acid metabolism and arachidonic acid metabolism belonged to the lipid metabolism. Researchers have reported that the statins could cure the SANFH and the possible mechanism was correcting the lipid metabolism disorder [15,16]. Lipid metabolism was the core metabolism and was closely associated with several hypotheses [2-4, 8, 9].…”

“…Researchers discovered that the statins could prevent the SANFH through correcting the lipid metabolism disorder [15,16]. Yin H et al [15] believed that simvastatin could enhance the effects of multiple decompressions in preventing progression of SANFH and reducing the risk of femoral head collapse.…”

Untargeted metabolomics reveals the effect of lovastatin on steroid-induced necrosis of the femoral head in rabbits

“…The use of statins in the treatment of steroid-induced necrosis of the femoral head has become popular in the past years [16,36]. As the clinical medicine, the statins have been proved that were useful in preventing steroid-induced necrosis of the femoral head in clinical treatment [15]. However, the key metabolic pathways and potential biomarkers were not clear.…”

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

“…Femoral head preservation procedures have been preferred for treatment in its early stages. [8][9][10][11][12] Moreover, total hip arthroplasty (THA) is typically performed when femoral head collapse and/or end-stage arthritis occurs. 8,13 While multiple treatment algorithms have been suggested, 3,5,[14][15][16] the surgical procedure to be performed at different stages remains controversial.…”