Osteonecrosis Femoral Head Treatment by Core Decompression and ILIAC CREST-TFL Muscle Pedicle Grafting

Babhulkar, Sudhir

doi:10.5772/30383

Cited by 2 publications

(2 citation statements)

References 30 publications

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“…They have shown good clinical& radiological outcome with free vascularisedbone graft in Ficat stages IIB and III also. However these procedure are technically demanding, tedious and time consuming and not feasible bilaterally in one sitting [23,24]. To overcome the short-comings of vascularised grafts, various types of muscle pedicle bone grafting procedure (after core decompression) have been described.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Management of AVN of Femoral Head by Decompression with TFL Muscle Pedicle Bone Graft and Fibular Graft

Das¹,

Datta²,

Parvez³

et al. 2021

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Background: Avascular necrosis (AVN) of the femoral head usually occurs in the active age of life, and is an increasingly common cause of musculoskeletal disability. Objective: we envisage to evaluate and compare the clinic oradiological outcomes between TFL muscle pedicle bone graft and no vascularized fibular grafting after core decompression prior to hip joint involvement of AVN femoral head provides painless and mobile life. Method: January 2013 to December 2019, total 64 hips (44 patients) in the age group of 18-48 years (mean 30.36±4.64 years) were included in this prospective study. Ficat and Arlet staging system was used, Stage I (n=10 hips), Stage II (n=44 hips) and stage III (n=10) of AVN of femoral head, were included after clinical and radiological evaluation, where 32 hips (half of all stage-I, II and III) were treated with fibular graft (Group 1) and rest 32 hips were treated with TFL muscle pedicle bone graft (Group 2) after decompression of femoral head. Preoperative Harris Hip Score (HHS), visual analog score (VAS), plain radiographs, and magnetic resonance imaging (MRI) were compared with serial postoperative HHS, VAS, plain radiographs at regular interval. The average follow up was 56 months. Result: Out of 44 patients, male was 28 (63.64%) and female was 16 (36.36%). Failure of surgery was defined as progression of the disease, which was n=1,10% (1/5, 20% in group 1, 0% in group-2) in stage I, n=12/44, 27.27% (7/22, 31.82% in group-1 and 5/22, 22.73% in group-2) in stage II and n=5/10, 50% (2/5, 40% in group 1 and 3/5, 60% in group 2) in stage III disease. Median values of HHS at the end of the follow up in Group I was 80 and 76 in Group 2, compared to the preoperative HHS of 56 and 52 respectively.. Overall satisfactory result was 71.88%, p value was <0.01, that is significant. In group 1 satisfactory result was 22/32 (68.75%) but 24/32 (75%) in group 2, no statistical significant difference (>0.05) between two groups. Even in early stage III disease, only 50% was effective. Conclusion: Core decompression with bone graft is effective in preserving the sphericity of the femoral head and to delay the progression in the early stages of the AVN of femoral head, (Stage I and II), fibular graft gives early stability but long term results are similar in both group.

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Section: Discussionmentioning

confidence: 99%

Comparison of Management of AVN of Femoral Head by Decompression with TFL Muscle Pedicle Bone Graft and Fibular Graft

Das¹,

Datta²,

Parvez³

et al. 2021

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show abstract

“…They have shown good clinical and radiological outcome with free vascularized bone grafts have in Ficat stages IIb, III and IV. However, these procedures are technically demanding, tedious and time-consuming and may not be feasible bilaterally, in one sitting [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Sartorius muscle pedicle iliac bone graft for the treatment of avascular necrosis of femur head

et al. 2016

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Avascular necrosis (AVN) of femoral head needs to be addressed early in the course of the disease, to prevent progression to osteoarthritis. A revascularizing procedure which can help preserve the head should be considered in young adults to alleviate the need for total hip arthroplasty. We included 40 cases (53 hips) of AVN of femoral head operated with Sartorius muscle pedicle iliac bone grafting, done by the senior author. Early post-operative rehabilitation was done. The weight bearing was delayed for 6 weeks. All the patients were followed clinically and radiologically at regular intervals. The operated femoral heads, were grouped according to Ficat’s staging: 24 in stage IIA (45.3%), 22 in stage IIB (41.5%) and 07 in stage III (13.2%). The average duration of surgery was 85 min (range: 55–130 min). The total duration of follow-up was average 4.2 years (range: 2.2–15 years).The Harris hip score was excellent (>90) in 18 hips (33.96%), good (80–89) in 24 hips (45.28%), fair (70–79) in 9 hips (17%) and poor (<70) in 2 hips (3.7%). AVN of the femoral head is a painful and disabling condition in young adults. Sartorius muscle pedicle bone graft technique allows adequate decompression, re vascularization and osteogenesis of the femur head in Ficat’s stage IIa, IIb and III, in young adults. This is an effective and easy technique to adopt with excellent to good results in 80% cases and is associated with only minimal complications.

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Osteonecrosis Femoral Head Treatment by Core Decompression and ILIAC CREST-TFL Muscle Pedicle Grafting

Cited by 2 publications

References 30 publications

Comparison of Management of AVN of Femoral Head by Decompression with TFL Muscle Pedicle Bone Graft and Fibular Graft

Comparison of Management of AVN of Femoral Head by Decompression with TFL Muscle Pedicle Bone Graft and Fibular Graft

Sartorius muscle pedicle iliac bone graft for the treatment of avascular necrosis of femur head

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