Factors affecting result of a conservative treatment in post-collapse osteonecrosis of femoral head.

Abstract

Background: Osteonecrosis of the femoral head (ONFH) affects the quality of life of patients. In our institute it was found that some patients in the post-collapse state denied having an operation, and considered continuing conservative treatment. Hence, the purpose of this study was to compare patient characteristics between patients who had total hip arthroplasty and those still on conservative treatment. Material and Methods: Data of seventy patients who had osteonecrosis of the femoral head with femoral head collapse were collected from the hospitals electronic database. All patients underwent the same approach in consideration of THA. The advice related to the indication of THA was for when pain did not decrease by conservative treatment, or improvement did not meet the patient’s requirement for lifestyle and daily living. The patient’s demographic data, physical examination and hip radiographic data were recorded. Results: There were 29 patients (40 hips) who had THA, while 31 patients (45 hips) were still undergoing conservative treatment. There were no differences in the patients’ base demographic data. However, patients who had THA had a lower rate of history of previous core decompression before head collapse than patients who were still undergoing conservative treatment (90.3% and 37.9%, p < 0.01). In the conservative treatment group, it was found that most of the cases had femoral head collapse at the superolateral head, while patients in the THA group had an increased number of patients having collapse at the superomedial part of the femoral head. Conclusion: This study reveals that patients considering the continuation of conservative treatment had a higher rate of history of core decompression and a lower rate of supermedial femoral head collapse. Thus, these factors might be considered in the discussions with patients concerning the prognosis of the disease.

Keywords

• osteonecrosis
• hip
• conservative treatment
• total hip arthroplasty

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