The Role of Conservative Management in the Avascular Necrosis of the Femoral Head: A Review of Systematic Reviews

Abstract

Introduction/Background Multiple medical and surgical treatments have been described in the early stages of Avascular Necrosis (AVN) of the femoral head which delay the disease progression. Similarly, multiple studies, trials, reviews, and systematic reviews exist for the various treatments described and their outcomes but with no consensus over which is superior. So in this study, we reviewed the systematic reviews of all the conservative therapies for AVN of the femoral head systematically to identify a single or a combination of non-surgical treatment choices in the initial stages of the disease. Methodology A thorough literature search has been carried out in January 2022 through the use of Pubmed, EMBASE, and Cochrane electronic databases using PRISMA guidelines. The Mesh words and Keywords used were “femoral head AVN”, “Conservative management”, and “Systematic Reviews”. The inclusion criteria used during the screening were, any systematic reviews which included patients with AVN either idiopathic or secondary, who are managed with conservative therapies like bisphosphonates, Hyper Baric Oxygen Therapy (HBOT), Shock wave therapies like Extracorporeal Shock Wave Therapy (ESWT), or electrical therapy like Pulsed Electro Magnetic Field (PEMF). The quality of the included systematic reviews was assessed using AMSTAR-2 criteria. Results The initial search yielded 364 studies which on screening based on our inclusion criteria finally resulted in seven systematic reviews to be included in the present study. There were two systematic reviews for Hyper Baric Oxygen Therapy (HBOT), two for Extracorporeal Shock Wave Therapy (ESWT), one for electrical stimulation modalities like Pulsed Electro Magnetic Field (PEMF), and two for bisphosphonates. The follow-up of the patients in the included systematic reviews varied from 6 weeks to 10 years. The total number of patients varied from 77 to over 1000 across the systematic reviews. Almost all of the studies included a control group that either received the intended treatment with adjuncts or did not receive any treatment at all. Because of the heterogeneous nature of included articles in the systematic reviews, meta-analysis was performed in only three of the included systematic reviews. Conclusion Of all the modalities of treatment described, bisphosphonates are easily available and cost-effective and do not require any hospital resources/machinery for delivering the treatment. So they can be used as an initial line of treatment for patients with early stages of AVN (Ficat and Arlet 1–3) and based on the hospital availability of resources could be supplemented with any of the biophysical modalities (ESWT/PEMF/HBOT) for maximum efficacy to delay the disease progression. Level of Clinical Evidence Systematic review. Supplementary Information The online version contains supplementary material available at 10.1007/s434...

A Comprehensive Review of Treatment Strategies for Early Avascular Necrosis

“…Understanding the factors contributing to diverse treatment responses is essential for refining treatment algorithms and optimizing the effectiveness of interventions for each patient with AVN. Ongoing research explores the complexities of individualized treatment responses in this multifaceted condition [ 62 ].…”

Osseoscopy-assisted core decompression and debridement in the treatment of avascular necrosis of the femoral head

“…[3] Whatever the cause, this process usually results in the collapse of the femoral head and subsequent osteoarthritis of the hip joint, depending on the severity of the pathology. [4] Although conservative treatment methods are available, such as limited weight bearing, [5] pharmacological agents, extracorporeal shock-wave therapy, and hyperbaric oxygen therapy at the initial level of progression, [6,7] the success rates are generally reported lower compared to surgical methods. [7] Core decompression is currently the most common surgical procedure in the early stages of osteonecrosis of the femoral head, [2] according to Steinberg classification stages I, II, and III.…”

Conservative Treatment in Avascular Necrosis of the Femoral Head: A Systematic Review

“…For instance, there is growing evidence that judiciously managed non-surgical interventions can not only alleviate symptoms but may also prevent or delay the need for more invasive procedures, particularly in younger patients who may be looking at several decades of joint usage [ 7 ]. Furthermore, the patient-centered approach in modern healthcare underscores the need for interventions that are not only effective but also align with the patients’ lifestyles, occupational needs, and long-term health goals [ 8 ]. Conservative treatments often meet these criteria, as they tend to be less invasive, have reduced recovery times, and align more seamlessly with patients’ daily lives compared to surgical options.…”