Abstract
Background
Avascular necrosis (AVN) of the femoral head usually occurs in the third to fifth decade. The treatment options depend on the stage of disease varying from nonoperative treatment to surgical procedure including core decompression (CD) with or without nonvascularized or vascularized fibular graft, muscle pedicle bone grafting, osteotomies, and arthroplasty. Finite life of the total hip arthroplasty (THA) prosthesis limits its use in young adults or in middle aged. In this study, we envisage to evaluate the clinicoradiological outcomes of CD and nonvascularized fibular grafting in early stages of AVN femoral head.
Materials and Methods
Our study is longitudinal observational study including 76 hips (46 patients) in the age group of 18–48 years (mean 30.07 years). Ficat and Arlet staging system was used and only early stages, that is, Stage 1 (n = 36 hips) and Stage 2 (n = 40 hips) were included in the study. The cases with traumatic AVN were excluded. All patients in Stage 1 underwent CD (Group 1) and those in Stage 2 underwent CD and fibular grafting (Group 2). 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, and MRI taken at different intervals.
Results
Average period of followup was 53.5 months (44–63 months). Radiological progression was not seen in 55 hips out of 76 hips (72.3%), whereas 21 hips (27.6%) demonstrated signs of progression and collapse. Failure of surgery was defined as progression of the disease, which was 25% (n = 9) in Group 1 and 30% (n = 12) Group 2. Median values of HHS at the end of the followup in Group 1 was 77 and in Group 2 was 71.5 compared to the preoperative HHS of 48 and 62 in Group 1 and 2, respectively. Median values of VAS at the end of the followup in Stage 1 was 0 and in Stage 2 was 2 compared to the preoperative VAS of 6 and 8 in Group 1 and Group 2, respectively.
Conclusion
CD with or without fibular grafting is effective in preserving the sphericity of the femoral head and to delay the progression of the AVN of femoral head in the early stages, that is, Stage 1 and Stage 2 and aids in the early revascularization of ischemic femoral head and is a useful modality to negate or delay the requirement of THA.
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References
Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: Ten years later. J Bone Joint Surg Am 2006;88:1117–32.
Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: Management in the 21st century. Instr Course Lect 2003;52:337–55.
Nam KW, Kim YL, Yoo JJ, Koo KH, Yoon KS, Kim HJ, et al. Fate of untreated asymptomatic osteonecrosis of the femoral head. J Bone Joint Surg Am 2008;90:477–84.
Tripathy SK, Goyal T, Sen RK. Management of femoral head osteonecrosis: Current concepts. Indian J Orthop 2015;49:28–45.
Babhulkar S. Osteonecrosis: Early diagnosis, various treatment options and outcome in young adults. Indian J Orthop 2006;40:138–46.
Tsai SW, Wu PK, Chen CF, Chiang CC, Huang CK, Chen TH, et al. Etiologies and outcome of osteonecrosis of the femoral head: Etiology and outcome study in a Taiwan population. J Chin Med Assoc 2016;79:39–45.
Marker DR, Seyler TM, Ulrich SD, Srivastava S, Mont MA. Do modern techniques improve core decompression outcomes for hip osteonecrosis? Clin Orthop Relat Res 2008;466:1093–103.
Shah SN, Kapoor CS, Jhaveri MR, Golwala PP, Patel S. Analysis of outcome of avascular necrosis of femoral head treated by core decompression and bone grafting. J Clin Orthop Trauma 2015;6:160–6.
Mont MA, Jones LC, Sotereanos DG, Amstutz HC, Hungerford DS. Understanding and treating osteonecrosis of the femoral head. Instr Course Lect 2000;49:169–85.
Stulberg BN, Davis AW, Bauer TW, Levine M, Easley K. Osteonecrosis of the femoral head. A prospective randomized treatment protocol. Clin Orthop Relat Res 1991;268:140–51.
Smith SW, Fehring TK, Griffin WL, Beaver WB. Core decompression of the osteonecrotic femoralhead. J Bone Joint Surg Am 1995;77:674–80.
Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res 1996;324:169–78.
Steinberg ME. Core decompression. Semin Arthroplasty 1998;9:213–20.
Stulberg BN, Singer R, Goldner J, Stulberg J. Uncemented total hip arthroplasty in osteonecrosis: A 2- to 10-year evaluation. Clin Orthop Relat Res 1997;334:116–23.
Mont MA, Einhorn TA, Sponseller PD, Hungerford DS. The trapdoor procedure using autogenous cortical and cancellous bone grafts for osteonecrosis of the femoral head. J Bone Joint Surg Br 1998;80:56–62.
Boettcher WG, Bonfiglio M, Smith K. Non-traumatic necrosis of the femoral head. II. Experiences in treatment. J Bone Joint Surg Am 1970;52:322–9.
Smith KR, Bonfiglio M, Montgomery WJ. Non-traumatic necrosis of the femoral head treated with tibial bone-grafting. A followup note. J Bone Joint Surg Am 1980;62:845–7.
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Lakshminarayana, S., Dhammi, I.K., Jain, A.K. et al. Outcomes of Core Decompression with or without Nonvascularized Fibular Grafting in Avascular Necrosis of Femoral Head: Short Term Followup study. JOIO 53, 420–425 (2019). https://doi.org/10.4103/ortho.IJOrtho_310_18
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DOI: https://doi.org/10.4103/ortho.IJOrtho_310_18