Osteotomies for avascular necrosis of the femoral head

Abstract

Background In osteonecrosis of the femoral head (ONFH), blood supply is insufficient for the metabolic requirements of the bone. The initial management is conservative, and, in case of failure, surgery is indicated. Osteotomies aim to change the spatial position of the necrotic portion of the femoral head. This systematic review evaluates the effectiveness and safety of osteotomies for ONFH. Source of data The systematic review, organized, conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, was performed on PubMed and Google Scholar. We analysed outcomes in term of Harris Hip Score, leg shortening, secondary collapse and blood loss. We also verified the percentage of patients who required total hip replacement (THR) after osteotomy for ONFH. Areas of agreement A total of 16 articles were selected, including 775 patients and 852 osteotomies [curved varus osteotomy in 369 (43.3%) patients; transtrochanteric rotational osteotomy in 435 (51.05%) patients; half wedge osteotomy in 48 (5.6%) patients]. There was an overall THR conversion rate of 31.5% (268 hips on 852 osteotomies). Areas of controversy There were no prospective randomized trials, and the outcome measures employed were often heterogeneous. Growing points Approximately one-third of the osteotomies performed in cases of ONFH are converted to THR over a period of ~7 years. In older patients, primary THR should be considered, especially as the conversion to THR after osteotomy is technically demanding. Areas timely for developing research Randomized clinical studies should be conducted in order to define the parameters of the patient that can direct towards the most suitable osteotomic technique.

Insufficient blood supply of fovea capitis femoris, a risk factor of femoral head osteonecrosis

“…An osteotomy was a treatment for ONFH by changing the spatial position of the necrotic portion of the femoral head. However, Quaranta et al have reported that approximately one-third of the osteotomies performed in cases of ONFH were converted to THR over 7 years [ 25 ]. The information of nutrient foramina in the fovea capitis femoris mentioned in this study might be used to define the parameters of the patient and improve the outcome of the osteotomy technique.…”

Treatment of pre-collapse non-traumatic osteonecrosis of the femoral head through Orthopdische Chirurgie München approach combined with autologous bone mixed with β-tricalcium phosphate porous bioceramic bone graft: a retrospective study of mid-term results

“…In addition, it has a higher complication rate, including the non-union or delayed union of bone at the osteotomy, failure of internal fixation, etc. [ 11 , 15 , 16 ]. Vascularized bone grafts require a high surgical technique, long operation time, extensive trauma, and have highly variable long-term success rates [ 17 , 18 ].…”

“…However, conservative treatment can relieve pain but cannot prevent the process of necrosis, hence the effect is limited. Surgical treatments include core decompression, platelet-rich plasma or bone marrow mesenchymal stem cells, vascularized bone graft, non-vascularized bone graft, and osteotomy [ 9 – 11 ]. Core decompression is accepted by most orthopedic surgeons as the preferred option for the treatment of ONFH but with wide variation in clinical outcomes [ 12 ].…”

Dysregulation of SAA1, TUBA8 and Monocytes Are Key Factors in Ankylosing Spondylitis With Femoral Head Necrosis

“…Femoral head necrosis, a common clinical disease with a high disability rate, is caused by factors such as excessive alcohol consumption and the heavy use of short-term high-dose glucocorticoids (5). In the disease process of femoral head necrosis, the blood supply is not sufficient to maintain the needs of bone metabolism, and the early treatment of the disease is mainly through conservative treatment, and in case of failure of conservative treatment, surgical treatment is required (6). Bukowski et al evaluated 174 patients with AS who underwent total hip arthroplasty and demonstrated an incidence of the posterior hip dislocation of approximately 8% over 20 years (7).…”