Osteonecrosis Of The Femoral Head. Results Of Core Decompression With And Without A Suction Drain

Öz

Objectives: The aim of this study is to compare the clinical outcomes of the femoral head osteonecrosis treatead with core decompression (CD) combined with a suction drain into the core tract versus simple CD. Materials and Methods: Thirtynine osteonecrotic hips in 25 patients were divided into 2 groups. Patients in group 1 (19 hips) were treated with CD, and those in group 2 (20 hips) received suction drain into the core tract after CD. Outcome between the 2 groups were compared clinically. Clinical assessments included assessment Harris hip score (HHS). Difference in HHS between the two groups were calculated using the Mann-Whitney U test. Results: At the end 6 months, patients compared with HHS. No significant differences were found between the two groups, but there was significant statical difference within the groups. Conclusions: Treatment of the early stage of osteonecrosis of the femoral head with CD improved the HHS but combined with the a suction drain into the core tract after CD seems to be not better than simple CD

Anahtar Kelimeler

• Osteonecrosis of the femoral head
• Core decompression
• Hip

FEMUR BAŞI OSTEONEKROZU: VAKUM DRENLİ VE VAKUM DRENSİZ KOR DEKOMPRESYON SONUÇLARI

Öz

Amaç: Bu çalışmanın amacı sadece kor
dekompresyon yapılan hastalar ile kor
dekompresyondan sonra, açılan tünele
vakumlu dren konulan hastaların
sonuçlarını karşılaştırmaktır.
Yöntem ve Gereç: 25 hastanın 39 kalçası
iki eşit gruba bölündü. Birinci gruba
(n=19) sadece kor dekompresyon, ikinci
gruba (n=20) ise kor dekompresyondan
sonra açılan tünele vakumlu dren konuldu.
İki gup arasındaki fark klinik olarak
karşılaştırıldı. Klinik olarak Harris kalça
skorlaması kullanıldı. İki grubu
karşılaştırmak için Mann-Whitney U testi
uygulandı.

Bulgular: Altıncı ayda, Harris kalça
skorlaması ile hastalar karşılaştırıldığında
iki grup arasında anlamlı fark bulunamadı.
Fakat gruplar kendi içinde
karşılaştırıldığında kor dekompresyonun
sonuçları önemli ölçüde iyileştirdiği
gözlenmiştir.
Sonuç: Erken evre osteonekrozun
tedavisinde kor dekompresyon Harris kalça
skorunu önemli ölçüde iyileştirmiştir fakat
kor dekompresyon ile açılan tünele
vakumlu dren konulmasının, sonuç üzerine
herhangi bir etkisi olmadığı gözlenmiştir.

Anahtar Kelimeler

• Femur başı osteonekrozu
• Kor dekompresyon
• Kalça

Kaynakça

1. Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone
2. Joint Surg Am 1995;77(3):459-74.
3. Lavernia CJ, Sierra RJ, Grieco FR. Osteonecrosis of the femoral head. J Am Acad Orthop
4. Surg 1999;7(4):250–61.
5. Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to
6. prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A
7. randomized clinical study. J Bone Joint Surg Am2005; 87(10):2155–9.
8. Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the

9. treatment of AVN of the hip. A prospective open-label study. Rheumatology
10. ;44(3):352–9.
11. Reis ND, Schwartz O, Militianu D, Ramon Y, Levin D, Norman D, et al. Hyperbaric
12. oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head. J Bone
13. Joint Surg Br 2003;85(3):371–5.
14. Aaron RK, Steinberg ME. Electrical stimulation of osteonecrosis of the femoral head.
15. Semin Arthroplasty 1991;2(3):214–21.
16. Wang CJ, Wang FS, Huang CC, Yang KD, Weng LH, Huang HY. Treatment for
17. osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core
18. decompression and bone-grafting. J Bone Joint Surg Am2005;87(11):2380–7.
19. Linovitz RJ, Pathria M, Bernhardt M, Green D, Law MD, McGuire RA, et al. Combined
20. magnetic fields accelerate and increase spine fusion: a double blind, randomized, placebo
21. controlled study. Spine 2002;27(13):1383–9.
22. Radke S, Kirschner S, Seipel V, Rader C, Eulert J. Magnetic resonance imaging criteria
23. of successful core decompression in avascular necrosis of the hip. Skeletal Radiol
24. ;33(9):519–23.
25. Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for
26. osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res
27. ;(429):131–8.
28. Koo KH, Kim R, Ko GH, et al. Preventing collapse in early osteonecrosis of the femoral
29. head. A randomised clinical trial of core decompression. J Bone Joint Surg Br
30. ;77(6):870-4
31. Steinberg ME, Brighton CT, Corces A, Hayken GD, Steinberg DR, Strafford B, Tooze
32. SE, Fallon M. Osteonecrosis of thefemoral head. Results of core decompression and
33. grafting with and without electrical stimulation. Clin Orthop Relat Res.1989;(249):199–
34. -
35. Gangji V, Hauzeur JP. Treatment of osteonecrosis of the femoral head with implantation
36. of autologous bone-marrow cells. Surgical technique. J Bone Joint Surg Am
37. ;87(1):106-112.
38. Hernigou P, Beaujean F. Treatment of osteonecrosis with autologous bone marrow
39. grafting. Clin Orthop Relat Res. 2002;(405):14–23.
40. Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, Hartman KE.
41. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin
42. Orthop Relat Res 2001;(386):71–78.
43. Yoo MC, Chung DW, Hahn CS. Free vascularized fibula grafting for the treatment of
44. osteonecrosis of the femoral head. ClinOrthop Relat Res. 1992;(277):128–138.
45. Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH. Vascularized compared with
46. nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone
47. Joint Surg Am. 2005;87(9):2012–2018.
48. Plakseychuk AY, Kim SY, Park BC, Varitimidis SE, Rubash HE, Sotereanos DG.
49. Vascularized compared with nonvascularized fibular grafting for the treatment of
50. osteonecrosis of the femoral head. J Bone Joint Surg Am 2003;85(4):589–596.
51. Steinberg ME, Steinberg DR Classification systems for osteonecrosis: an overview.
52. Orthop Clin North Am 2004;35(3):273–283
53. Camp JF, Colwell CW Jr. Core decompression of the femoral head for osteonecrosis. J
54. Bone Joint Surg Am 1986;68(9):1313-1319.
55. Hopson CN, Siverhus SW. Ischemic necrosis of the femoral head. Treatment by core
56. decompression. J Bone Joint Surg Am 1988;70(7):1048–1051.
57. Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE et al. Core
58. decompression with bonegrafting for osteonecrosis of the femoral head. Clin Orthop
59. Relat Res 2001;(386):71–78.
60. Petrigliano FA, Lieberman JR. Osteonecrosis of the hip: novel approaches to evaluation
61. and treatment. Clin Orthop RelatRes 2007;(465):53–62.
62. Ficat RP. Idiopathic bone necrosis of the femoral head: early diagnosis and treatment. J
63. Bone Joint Surg Br 1985;67(1):3-9.
64. Mont MA, Carbone J J, Fairbank AC: Core decompression versus non-operative
65. management for osteonecrosis of the hip. Clin Orthop 1996;(324):169-78.
66. Zhao FC, Li ZR, Zhang NF, Wang BL, Sun W, Cheng LM et al. Lesion size changes in
67. osteonecrosis of the femoral head: a long-term prospective study using MRI. Int Orthop
68. ;34(6):799-804.