What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head?

Abstract

Purpose Core decompression (CD) of the femoral head is performed to preserve the hip in avascular necrosis (AVN). The outcome following this procedure differs based on the medical centre and the technique. Also, the time to total hip replacement (THR) and the percentage of patients subsequently undergoing a THR are controversial. Methods A systematic review was performed following PRISMA guidelines. The search included CENTRAL, MEDLINE, EMBASE, Scopus, AMED and Web of Science Core Collection databases. Studies reporting the outcome of CD for AVN were assessed. Studies using additional implants, vascularized grafts or any type of augmentation were excluded. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC) tool. Trial registration International prospective register of systematic reviews (PROSPERO) - CRD42018100596. Results A total of 49 studies describing 2540 hips were included. The mean weighted follow-up time was 75.1 months and the mean age at surgery was 39 years. Twenty-four of 37 studies reported improvement in all outcome scores, whilst 9/37 studies report only partial improvement post-operatively. Four studies (4/37) described poor clinical outcomes following intervention. Data was pooled from 20 studies, including 1134 hips with a weighted mean follow-up of 56 months. The percentage of hips undergoing THR averaged 38%. The time to THR had a weighted mean of 26 months after CD. Conclusion Pooled results from 1134 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 38% of patients underwent a total hip replacement at an average of 26 months following core decompression without augmentation.

Multiple drilling is not effective in reducing the rate of conversion to Total hip Arthroplasty in early-stage nontraumatic osteonecrosis of the femoral head: a case-control comparative study with a natural course

“…Another meta-analysis also indicated that multiple drilling did not have significantly better effect on the prevention of THA progression than other therapeutic interventions [ 23 ]. The rate of survival following multiple drilling (78.3%) in our cohort appears to be higher than that reported by the majority of previous studies [ 6 , 24 ]. The possible reason may be that the present study included only ONFH hips with modified Ficat and Arlet stage I and II.…”

Nomogram to predict collapse-free survival after core decompression of nontraumatic osteonecrosis of the femoral head

“…While standard CD was the most widespread joint-preserving procedure proposed in the recent decade, Al Omran [ 28 ] reported that no differences were found in the outcome or complication rate between patients who underwent standard CD and multiple drilling at a mean 3-year follow-up. In our cohort, multiple drilling was used in all included patients of precollapse NONFH with relative better outcomes than prior studies [ 29 , 30 ]. A possible interpretation might include the following: first, multiple drilling with small diameter pin could easily reach the anterior portion of the femoral head reducing intraosseous hypertension; second, the technique was one of the mini-invasive interventions which could reduce the possibility of penetrating the femoral head and damaging the articular cartilage; third, due to the small diameters of drilling, the procedure provided mechanical support, retained the anatomic structure of the femoral head, and reduced the risk of subtrochanteric fracture.…”

The outcome of arthroscopic surgery in young adults and adults with osteonecrosis: A systematic review and meta-analysis

“…Several studies reported the advantages of arthroscopy in AVNFH as regards the reduction of THR and improvement of HHS [9,29,31] . Moreover, arthroscopy is preferred over open surgery due to the small incision and minimization of manipulation damage to the articular cartilage as well as its diagnostic role [7,32,33] . As the synthesis of the information is lacking, as far as we know, therefore, the purpose of this review is to explore the efficacy of arthroscopy to salvage hip joints in selected cases and to minimize the need for THR in young adults patients with AVNFH.…”