The effect of the Japanese Investigation Committee classification on hip joint survival after core decompression therapy in pre-collapsed avascular necrosis of the femoral head

Year 2024, Volume: 15 Issue: 3, 455 - 462, 30.09.2024

Erkan Akgün , İbrahim Kaya , Ahmet Topçuoğlu , Hüseyin Emre Tepedelenlioğlu , Ahmet Fırat

https://doi.org/10.18663/tjcl.1544925

Abstract

Aim: This study aimed to determine the failure rate of pre-collapse avascular necrosis (AVN) of the femoral head treated with core decompression (CD) and risk factors affecting the progression of the disease in patients by using an easily applicable staging system. .
Material and Methods: A total of 174 hips from 134 patients diagnosed with precollapse AVN and treated with CD were retrospectively examined. Each hip was classified using the Japanese Investigation Committee (JIC) classification. The endpoint for joint survival following treatment was defined as the occurrence of total hip arthroplasty (THA). The risk analysis on joint survival of various independent variables (treatment type, age, gender, etiology) and the frequency of THA 2 and 5 years after treatment was calculated.
Results: The mean age of the patients was 44.0 ± 15.0 years, with the majority being male (71.8%). THA was performed in 28.7% of treated hips within two years and 40.2% within five years. The frequency of THA application within two years was 2% for type A, 8% for type B, 40% for type C1 and 50% for type C2. Age (p=0.033), type C1 (p=0.028) and type C2 (p<0.01). The rate of post-treatment THA in patients with AVN due to steroid use was found to be significantly higher than in other etiologies (p<0.001). The average survival time of type C1 hips despite treatment is 58.5 months, while the average survival time of type C2 hips is 42.8 months.
Conclusion: In patients with type C1 and C2, hip survival times are significantly shorter than those of type A and type B hips, regardless of previous treatment, and it is a risk factor for THA. Additionally, history of steroid use and age were found to be independent risk factors that shorten hip joint survival.

Keywords

avascular necrosis, core decompression, femoral head, classification, total hip arthroplasty

Project Number

2023-777

Japon İnceleme Komitesi sınıflandırmasının, femur başı prekollaps avasküler nekrozunda kor dekompresyon tedavisi sonrası kalça eklemi sağkalımı üzerindeki etkisi

Abstract

Amaç: Bu çalışma, kor dekompresyon ile tedavi edilen prekollaps femur başı avasküler nekrozunun başarısızlık oranını ve hastalarda hastalığın ilerlemesini etkileyen risk faktörlerini kolay uygulanabilir bir evreleme sistemi kullanarak belirlemeyi amaçlamadı.
Gereç ve Yöntemler: Prekollaps avasküler nekroz tanısı almış ve kor dekompresyon ile tedavi edilmiş 134 hastanın 174 kalçası retrospektif olarak incelendi. Her kalça, Japon İnceleme Komitesi (JIC) sınıflandırması kullanılarak sınıflandırıldı. Tedavi sonrası eklem sağkalımının sonlanma noktası, total kalça artroplastisi yapılması olarak tanımlandı. Farklı bağımsız değişkenlerin (tedavi türü, yaş, cinsiyet, etiyoloji) eklem sağkalımına etkisi ve tedaviden sonraki 2 ve 5 yıl içinde THA sıklığı hesaplandı.
Bulgular: Hastaların ortalama yaşı 44.0 ± 15.0 yıl olup, çoğunluğu erkekti (%71,8). Tedavi edilen kalçaların %28,7'sine iki yıl içinde ve %40,2'sine beş yıl içinde THA yapıldı. İki yıl içinde THA uygulanma sıklığı tip A için %2, tip B için %8, tip C1 için %40 ve tip C2 için %50 idi. Yaş (p=0,033), tip C1 (p=0,028) ve tip C2 (p<0,01) anlamlı bulundu. Steroid kullanımına bağlı AVN'li hastalarda tedavi sonrası THA oranı diğer etiyolojilere göre anlamlı olarak daha yüksek bulundu (p<0,001). Tip C1 kalçaların tedaviye rağmen ortalama sağkalım süresi 58,5 ay iken, tip C2 kalçaların ortalama sağkalım süresi 42,8 aydı.
Sonuçlar: Tip C1 ve C2 olan hastalarda, kalça sağkalım süreleri, önceki tedaviden bağımsız olarak tip A ve tip B kalçalara göre anlamlı derecede daha kısadır ve bu, THA için bir risk faktörüdür. Ayrıca, steroid kullanım öyküsü ve yaş, kalça eklemi sağkalımını kısaltan bağımsız risk faktörleri olarak bulunmuştur.

Keywords

avasküler nekroz, kor dekompresyon, femur başı, sınıflandırma, total kalça artroplastisi

Ethical Statement

The study was approved by the Ankara Etlik City Hospital Clinical Research Ethics Committee (24/01/2024 - No: 2023-777).

Project Number

2023-777

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