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

Cover Page


Cite item

Abstract

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.

About the authors

R. M. Tikhilov

Vreden Russian Research Institute of Traumatology and Orthopedics Ul. Akad. Baykova, St. Petersburg; Mechnikov North Western State Medical University Kirochnaya ul., St. Petersburg

Email: fake@neicon.ru
Tikhilov Rashid M. - professor, director of Vreden Russian Research Institute of Traumatology and Orthopedics; professor of department of traumatology and orthopedics of MNSMU Russian Federation

I. I. Shubnyakov

Vreden Russian Research Institute of Traumatology and Orthopedics Ul. Akad. Baykova, St. Petersburg

Email: fake@neicon.ru

Shubnyakov Igor I. - chief researcher 

Russian Federation

A. A. Myasoedov

Vreden Russian Research Institute of Traumatology and Orthopedics Ul. Akad. Baykova, St. Petersburg

Author for correspondence.
Email: myasoedov_alexei@mail.ru

Myasoedov Alexey A. - researcher of hip joint pathology department.

8, St. Petersburg, Russia, 195427; e-mail: myasoedov_alexei@mail.ru Russian Federation

A. A. Irzhansky

Vreden Russian Research Institute of Traumatology and Orthopedics Ul. Akad. Baykova, St. Petersburg

Email: fake@neicon.ru

Irzhansky Arseny А. -  clinical intern 

Russian Federation

References

  1. Ахтямов И.ф., Эакиров Р.Х., Лобашов В.В., Современные методы визуализации в диагностике остеонекроза головки бедренной кости. Вестник современно клинической медицины. 2014; 7(приложение 2): 30-39.
  2. Эагородний Н.В., Евгений Ш.Л., Батыгин Г.Г. Регистры по эндопротезированию тазобедренного сустава. Вестник Российского университета дружбы народов. Серия: Медицина. 2012;(3):66-71.
  3. Эоря В.И. Возможные причины асептического некроза головки бедренной кости у взрослых и вопросы его диагностики. Травматология и ортопедия России. 1994;(5):46-53.
  4. Конев В.А., Тихилов Р.М., Шубняков И.И., Мясоедов А.А., Денисов А.О. Эффективность использования биорезорбируемых материалов для заполнения костных полостей при остеонекрозе головки бедренной кости. Травматология и ортопедия России. 2014;(3):28-38.
  5. Корж А.А. Керамические имплантаты при хирургическом лечении асептического некроза головки бедренной кости. Ортопедия, травматология и протезирование. 1989;(10):1-3.
  6. Руководство по хирургии тазобедренного сустава / под редакцией Р.М. Тихилова, И.И. Шубнякова. СПб. : РНИИТО имени Р.Р. Вредена; 2014. Т. 1. 368 с.
  7. Тихилов Р.М., Воронцова Т.Н., Лучанинов С.С. Динамика основных показателей травматизма и заболеваемости костно-мышечной системы у населения Ленинграда Санкт-Петербурга (итоги тридцатилетнего мониторинга, проведенного с 1976 по 2007 гг.). Травматология и ортопедия России. 2008;(4):100-106.
  8. Тихилов Р.М., Воронцова Т.Н., Черный А.Ж., Лучанинов С.С. Состояние травматизма и ортопедической заболеваемости взрослого населения Санкт-Петербурга в 2009-2011 гг. и работа травматолого-ортопедической службы города. Травматология и ортопедия России. 2012;(4):110-119.
  9. Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Черный А.Ж., Муравьева Ю.В., Гончаров М.Ю. Данные регистра эндопротезирования тазобедренного сустава РНИИТО имени Р.Р. Вредена за 2007-2012 годы. Травматология и ортопедия России. 2013;93:167-190.
  10. Aldridge J.M. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. Surgical technique. J Bone Joint Surg.Am. 2004;86, Suppl. 1:87-101.
  11. Gardeniers J.W.M. ARCO Report of the committee of staging and nomenclature. ARCO News Letter. 1993;5: 79-82.
  12. Hernigou P., Manicom O., Poignard A., Nogier A., Filippini P., Abreu L.D. Core decompression with marrow stem cells. Oper Tech Orthop. 2004;14:68-74.
  13. Hungerford D.S. Treatment of ischemicnecrosis of the femoral head. In: Evarts CD, editor. Surgery of the musculoskeletal system. Vol. 3. NewYork: Churchill Livingstone; 1983. p. 5029-5043.
  14. Keizer S.B., Kock N.B., Dijkstra P.D., Taminiau A.H., Nelissen R.G. Treatment of avascular necrosis of the hip by a non-vascularised cortical graft. J Bone Joint Surg Br. 2006; 88:460-466.
  15. Kim S.Y., Kim D.H., Park I.H. Multiple drilling compared with core decompression for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Br. 2004;86:149.
  16. Lausten G.S., Mathiesen B. Core decompression for femoral head necrosis: Prospective study of 28 patients. Acta Orthop Scand. 1990;51:507-511.
  17. Lieberman J.R., Conduah A., Urist M.R. Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop Relat Res. 2004;429:139-145.
  18. Mont M.A., Ragland P.S., Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small diameter drilling. Clin Orthop Relat Res. 2004;429:131-138.
  19. Mont M.A., CarboneJ.J, Fairbank A.C. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996;(324):169-178.
  20. Mont M.A., Hungerford D.S. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995; 77(3):459-474.
  21. Seyler T.M., Cui Q., Mihalko W.M. et al. Advances in hip arthroplasty in the treatment of osteonecrosis. Instr Course Lect. 2007;56:221-233.
  22. Shuler M.S., Rooks M.D., Roberson J.R. Porous tantalum implant in early osteonecrosis of the hip preliminary report on operative, survival and outcomes results. J Arthroplasty. 2007;22:26-31.
  23. Stein H., Volpin G., Horer D. Vascularized musclepedicle flap for osteonecrosis of the femoral head. Orthopedics. 2002;25:485-488.
  24. Swedish hip arthroplasty register annual report 2013 [http://www.shpr.se/en/Publications/DocumentsReports.aspx].
  25. Tsukanaka M., Halvorsen V., Nordsletten L., EngessTer I.0., EngessTer L.B., Fenstad A.M., Rohrl S. Implant survival and radiographic outcome of total hip replacement in patients less than 20 years old. Acta Orthop. 2016;20:1-6. [Epub ahead of print]
  26. Veillette C.J., Mehdian H., Schemitsch E.H., McKee M.D. Survivors hip analysis and radiographic outcome following tantalum rodinsertion for osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88:48-55.
  27. Yan Z.Q., Chen Y.S., Li W.J., Yang Y., Huo J.Z., Chen Z.R. et al. Treatment of osteonecrosis of the femoral head by percutaneous decompression and autologous bone marrow mononuclear cell infusion. Chin J Traumatol. 2006;9:3-7.

Copyright (c) 2016



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies