COMPARISON OF DIFFERENT CORE DECOMPRESSION TECHNIQUES FOR TREATMENT OF EARLY STAGES OF OSTEONECROSIS OF THE FEMORAL HEAD

Today one of the most interesting organ surgical interventions for patients with osteonecrosis of the femoral head are still different core decompression procedure. However, in the literature, we could not find any indication on what stage of the disease is different proposed techniques is the most effective.

Purpose of the study compare the results of different methods of core decompression in the early stages of the disease, before the development of hip osteoarthritis.

Materials and methods. From 2006 to 2015 we treated 84 patients (96 hips) with a diagnosis of osteonecrosis of the femoral head. The mean age of patients was 37,4±9,1 (from 18 to 71) years. Classification Association Research Circulation Osseous (ARCO) was used to determine the stage of the disease. 20 patients core decompression performed on stage II, 71 stage III and 5 in stage IV of disease. Core decompression by one tunnel 9 mm diameter was performed in 55 cases, and in 33 cases, the destruction of the core to the healthy bone has been made. Grafting of the residual cavity has been made by allogeneic bone, calcium sulfate, a combination of calcium sulfate and p3-calcium phosphate and p3-calcium phosphate. Eight joints operated by core decompression multiple tunnels of small diameter without subsequent plastic tunnels. We assessed the results on the basis of X-ray and CT scan data of the operated hip, and according to Oxford Hip Score at 3, 6 and 12 months, and then once in 1 year after surgery. In case of subsequent hip replacement was performed pathological examination area of core osteonecrosis of the femoral head.

Results. The average period of follow-up was 31,6 months (from 12 to 110 months). Preventing hip arthroplasty during this time managed in 43 cases (44.8%), 53 joints (55.2%), total hip replacement has been made in the period from 4 to 72 months (average 21.6 months) from the date of implementation of core decompression. The greater the number of good and satisfactory results have shown methods aimed at complete destruction of nonviable bone on the border of core osteonecrosis healthy bone.

Frequency of hip replacement is directly dependent on the stage of the disease.In the second stage of the disease hip replacement made in 4 cases (20%) at the third stage satisfactory performance were observed mainly in the case of small and medium sized core osteonecrosis of the femoral head (4, 18 and 16 of the joints 27, respectively). In the fourth stage of the disease arthroplasty was performed in all five cases.

Conclusions. Different techniques of core decompression are most effective before the formation of the Impressions of the loaded part of the femoral head, which corresponds to stage III ARCO classification inclusive. Efficacy techniques depends not only on the stage but also on the size and location core of osteonecrosis.