Natural history of nontraumatic avascular necrosis of the femoral head

Ohzono, Kenji; Saito, Masanobu; Takaoka, Kunio; Ono, Katsuhiko; Saito, Susumu; Nishina, Tetsuhiko; Kadowaki, Takatoshi

doi:10.1302/0301-620x.73b1.1991778

Cited by 304 publications

(174 citation statements)

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“…The event pathway for observation follows the clinical course of patients with early osteonecrosis and assumes that they become symptomatic and require THA after a 2-year period. This period is consistent with the natural history of osteonecrosis [1,21,22].…”

Section: Decision Modelsupporting

confidence: 84%

Cost-effectiveness Analysis of Core Decompression

SooHoo

Vyas

Manunga

et al. 2006

The Journal of Arthroplasty

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Core decompression is widely used to treat the early stages of osteonecrosis of the hip. The purpose of this analysis is to assist orthopedic surgeons in judging whether currently available data support the use of core decompression as cost-effective. A decision model was created for the treatment of osteonecrosis of the femoral head. Literature review was used to identify possible outcomes and their probability after initial treatment with either observation or core decompression. This model demonstrates core decompression must delay the need for total hip arthroplasty for a minimum of 5 years to maintain an incremental cost-effectiveness ratio lower than $50 000 per quality-adjusted life year gained. Treatment options with ratios higher than $50 000 per quality-adjusted life year are generally considered to have limited cost-effectiveness. This study demonstrates that core decompression has the potential to be a highly cost-effective alternative if it is leads to a delay in the need for total hip arthroplasty of 5 years or longer.

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Section: Decision Modelsupporting

confidence: 84%

Cost-effectiveness Analysis of Core Decompression

SooHoo

Vyas

Manunga

et al. 2006

The Journal of Arthroplasty

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“…Sugioka [27] also reported complications related to his procedure, including lesser trochanteric fracture in one, femoral neck fracture in four, delayed union in five leading to increased varus deformities, and progression of osteonecrosis in two. Ohzono et al [20] proposed a lack of skilled surgical technique or inappropriate patient selection or fixation causes a high failure rate. Our complications were not greatly different from those reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The etiology is unknown but the disease is characterized by the death of bone. Although in some cases the disease is static or progresses very slowly [20], in others it typically progresses to collapse of the subchondral bone and articular cartilage of the joint, ultimately leading to secondary degenerative change causing pain and limitation of joint motion.…”

Section: Introductionmentioning

confidence: 99%

“…Various head preservation procedures have been reported, such as core decompression which reduces bonemarrow pressure [8,21], proximal femoral osteotomy [9], nonvascularized or vascularized bone graft [3,5], and trochanteric or transtrochanteric rotational osteotomy [20,27]. Sugioka's transtrochanteric rotational osteotomy [27] especially is known as an effective head preservation procedure in younger patients.…”

Section: Introductionmentioning

confidence: 99%

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Modified Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis

Yoon

Abbas

Hur

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Osteonecrosis of the femoral head is a disabling condition affecting young patients and treatment of the disease in these patients is variable. We retrospectively reviewed 39 patients (43 hips) in whom a modified transtrochanteric rotational osteotomy was performed for osteonecrosis. The minimum followup was 24 months (mean, 36.6 months; range, 24-52 months). The mean patient age was 34.3 years (range, 20-51 years). Based on the ARCO classification, 17 hips were classified as Stage II and 26 as Stage III. We performed rotational osteotomy alone in 15 cases, in combination with simple bone grafting in three, and in combination with muscle-pedicle-bone grafting in 25. Sixteen of 17 ARCO Stage II cases and 24 of 26 ARCO Stage III cases had no progression of collapse or lesion size; three hips progressively collapsed. Of the 40 hips without progression the Harris hip score improved from a mean 70 to 92 points at final followup, as did the range of motion of the hip. Modified transtrochanteric rotational osteotomy is an effective method for delaying the progression of collapse in the treatment of selected cases of osteonecrosis of the femoral head.

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“…Nontraumatic ONFH usually affects young adults during the third to fourth decades of life, and most of the radiographically larger lesions progress to collapse, resulting in osteoarthritis without treatment [24,27,28,30,43]. The risk of collapse of the femoral head depends on the extent and location of the lesion [1,24,36].…”

Section: Introductionmentioning

confidence: 99%

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

Biswal

Hazra

Yun

et al. 2009

Clin Orthop Relat Res

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Transtrochanteric rotational osteotomy (TRO) is a controversial procedure with reported inconsistent results. We reviewed 50 patients (60 hips) who underwent this procedure for extensive osteonecrosis of the femoral head, focusing on varization to determine its effectiveness as a head-preserving procedure in young adults. The mean age of the patients was 28 years (range, 18-46 years). Using the Ficat-Arlet classification, 40 hips had Stage II and 20 hips had Stage III involvement. According to the classification system of Shimizu et al., the extent of the lesions were Grade C in 54 hips and Grade B in six hips; the location of the lesions were Grade c in 56 hips and Grade b in four hips. Minimum followup was 18 months (mean, 84 months; range, 18-156 months). The mean preoperative Harris hip score was 44.7 points (range, 32-62 points) which improved to an average postoperative score of 80.1 points (range, 44-100 points) at the latest followup. Forty-four hips showed no radiographic evidence of progression of collapse. Ten hips showed progressive collapse, seven hips showed progressive varus deformity, three hips had stress fractures of the femoral neck, and one hip had infection. We believe TRO with varization is worth attempting for extensive osteonecrosis of the femoral head in young adults, although failures and complications are not uncommon.

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Natural history of nontraumatic avascular necrosis of the femoral head

Cited by 304 publications

References 1 publication

Cost-effectiveness Analysis of Core Decompression

Cost-effectiveness Analysis of Core Decompression

Modified Transtrochanteric Rotational Osteotomy for Femoral Head Osteonecrosis

Transtrochanteric Rotational Osteotomy for Nontraumatic Osteonecrosis of the Femoral Head in Young Adults

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