Osteonecrosis of the Femoral Head. Optimizing the Early-Stage Joint-Preserving Surgical Treatment?

Abstract

Osteonecrosis of the femoral head (ONFH) is a debilitating condition with various etiologies. Comprehension of the pathophysiology of the disease is limited, adding to the challenge of devising a clinically effective treatment strategy. High clinical suspicion and magnetic resonance imaging aid early diagnosis, leading to less invasive and more effective treatment. Recent advancements in joint-preserving surgical treatment have led to improved outcomes, reduced pain, and a higher hip survival rate for early onset osteonecrosis of the femoral head compared with more invasive approaches such as total hip replacement. Core decompression is the gold standard procedure to relieve the ischemic area of the femoral head and is crucial in the early stage of osteonecrosis. The addition of biologic regenerative agents to core decompression is auspicious as they can introduce new cells to the area of necrosis, osteoinductive and osteoconductive agents, while enhancing healing and cellular repair. Adjunctive bone marrow-derived cell therapies have been advocated, potentially aiding the regenerative process. Arthroscopic core decompression and robot-assisted orthopaedic surgery are believed to improve the precision of graft placement, decreasing radiation and operative time. The current study provides a comprehensive review and update of the literature surrounding the latest developments regarding joint-preserving surgical treatment for patients with osteonecrosis of the femoral head. Keywords: osteonecrosis, core decompression, hip preservation, femoral head, avascular necrosis, bone-graft.

Comparison robot-assisted core decompression combined with human umbilical cord-derived mesenchymal stem cell transplantation and traditional surgery for treatment of osteonecrosis of the femoral head. A retrospective study

“…The exclusion criteria were as follows: (1) < 18 or > 60 years old; (2) ARCO stages 3 and 4; (3) patients with systemic infection or local skin infection around the incision; (4) patients who had received steroid treatment in the last 6 months; (5) patients complicated with in ammatory arthritis; (6) patients with a previous history of fracture or tumour in the proximal femur; (7) patients who had previously or still received other conservative treatments, such as hyperbaric oxygen and extracorporeal shock wave therapy; and (8) pregnant women.…”

“…After long-term clinical application, it has been proved that it can effectively alleviate the progress of osteonecrosis. Traditional core decompression surgery requires complex hand-eye coordination, and doctors need to manually control the guide needle, which may have a large deviation 5,6 .With the rapid development of intelligent robots, robot-assisted surgical treatment is gradually applied to clinical practice, which can achieve minimally invasive, accurate and personalized surgical operation to a greater extent 7,8 . In addition to successfully completing thoracolumbar fracture surgery and atlantoaxial joint internal xation surgery, TiRobot ™, the orthopedic navigation robot can be used to precisely implant different guide wires and screws in the proximal femur 9,10 .…”

Hip Arthroscopy Debridement Combined with Multiple Small‐Diameter Fan‐Shaped Low‐Speed Drilling Decompression in the Treatment of Early and Middle Stage Osteonecrosis of the Femoral Head: 14 Years Follow‐Up

“…Several surgical methods are currently available for preserving the hip, such as core decompression (CD), bone grafting, vascularized muscle flap or fibula grafting, and implantation of a porous tantalum rod 4 . While these methods delay the progression of osteonecrosis to some extent, they have certain limitations.…”

“…Several surgical methods are currently available for preserving the hip, such as core decompression (CD), bone grafting, vascularized muscle flap or fibula grafting, and implantation of a porous tantalum rod. 4 While these methods delay the progression of osteonecrosis to some extent, they have certain limitations. For instance, procedures like vascularized muscle flaps or fibula grafts, although capable of removing dead bone completely, are complicated and traumatic with long postoperative external fixation times that affect joint function recovery.…”

Complete Repair of Osteonecrosis of the Femoral Head After Basicervical Femoral Neck Rotational Osteotomy

“…Other hip preservation treatment options are available 2-7 , including nonsurgical approaches, such as pharmacologic treatments, physical therapy, shock-wave therapy, and hyperbaric oxygen therapy, and surgical interventions, such as core decompression, vascularized and nonvascularized bone grafting, and osteotomies. Femoral head rotational osteotomy is a surgical technique that can reposition the necrotic area of the femoral head out of the weight-bearing area, although its clinical efficacy varies in the literature 8-15 .…”