Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Hip Arthroscopy | Research article

Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5 year follow-up

Authors: Mark R. Nazal, Ali Parsa, Scott D. Martin

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Login to get access

Abstract

Background

Osteonecrosis of the femoral head (ONFH) is a progressive disease that leads to collapse and the development of secondary arthritis. The preferred management of ONFH remains controversial. Arthroscopic-assisted management of ONFH is a new and evolving approach for hip preservation. We hypothesis that arthroscopy is able to improve ONFH outcomes by achieving accurate and minimally invasive decompression while successfully addressing concomitant intraarticular pathologies resulting in reliable mid-term outcomes.

Methods

This was a retrospective cohort analysis. All patients had atraumatic ONFH with a precollapse lesion and a minimum follow-up of 5 years.

Results

A total cohort of 11 hips (8 patients) was identified. The mean patient follow-up was 7 years ±1.48 years (range, 64—118 months). The Ficat-Alret classification found on preoperative imaging was Stage I—3 (27.2%), IIa—4 (36.4%), and IIb—4 (36.4%) hips. Four (36.4%) hips experienced mechanical issues, including locking, catching, and buckling. The most common concomitant pathology addressed at the time of arthroscopy, was labral repair/debridement—8 (73%), followed by microfracture—7 (64%). At final follow-up, 6 hips (54.5%) had not converted to THA. Upon further stratification, Stage I—100%, Stage IIa—75%, for a combined 87%, had not converted to THA, in contrast, 100% of hips categorized as Stage IIb had converted to THA. Ficat-Alret staging, especially Stage IIb, was significantly associated with conversion to THA. (p-value = 0.015) There were 0% major or minor complications.

Conclusions

To our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA.

Level of evidence

Level IV, Case Series.
Literature
1.
Hungerford DS, Jones LC. Asymptomatic osteonecrosis: should it be treated? Clin Orthop Relat Res. 2004:124–30.CrossRef
2.
Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459–74.CrossRef
3.
Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015;6:590–601.CrossRef
4.
Papavasiliou A, Yercan HS, Koukoulias N. The role of hip arthroscopy in the management of osteonecrosis. J Hip Preserv Surg. 2014;1:56–61.CrossRef
5.
Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am. 2006;88:1117–32.PubMed
6.
Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop Relat Res. 1996:169–78.CrossRef
7.
Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic osteonecrosis of the femoral head: where dowe stand today? A ten-year update. J Bone Jt Surg Am Vol. 2014;97:1604–27.CrossRef
8.
Mont MA, Pivec R, Banerjee S, Issa K, Elmallah RK, Jones LC. High-Dose Corticosteroid Use and Risk of Hip Osteonecrosis: Meta-Analysis and Systematic Literature Review. J Arthroplasty. 2015;30:1506–1512.e5.CrossRef
9.
Ficat RP. Idiopathic bone necrosis of the femoral head early diagnosis and treatment; 1985.CrossRef
10.
Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J. 2017;99–B:1267–79.CrossRef
11.
Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect. 2003;52:337–55.PubMed
12.
Pierce TP, Jauregui JJ, Elmallah RK, Lavernia CJ, Mont MA, Nace J. A current review of core decompression in the treatment of osteonecrosis of the femoral head. Curr Rev Musculoskelet Med. 2015;8:228–32.CrossRef
13.
Mohanty SP, Singh KA, Kundangar R, Shankar V. Management of non-traumatic avascular necrosis of the femoral head—a comparative analysis of the outcome of multiple small diameter drilling and core decompression with fibular grafting. Musculoskelet Surg. 2017;101:59–66.CrossRef
14.
Ancelin D, Reina N, Cavaignac E, Delclaux S, Chiron P. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res. 2016;102:1029–34.CrossRef
15.
Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res. 2004:131–8.CrossRef
16.
Al OA. Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients. Arch Orthop Trauma Surg. 2013;133:609–13.CrossRef
17.
Ruch DS, Satterfield W. The use of arthroscopy to document accurate position of core decompression of the hip. Arthroscopy. 1998;14:617–9.CrossRef
18.
Guadilla J, Fiz N, Andia I, Sánchez M. Arthroscopic management and platelet-rich plasma therapy for avascular necrosis of the hip. Knee Surgery, Sport Traumatol Arthrosc. 2012;20:393–8.CrossRef
19.
Beck DM, Park BK, Youm T, Wolfson TS. Arthroscopic treatment of labral tears and concurrent avascular necrosis of the femoral head in young adults. Arthrosc Tech. 2013;2:e367–71.CrossRef
20.
Gupta AK, Frank RM, Harris JD, McCormick F, Mather RC, Nho SJ. Arthroscopic-assisted core decompression for osteonecrosis of the femoral head. Arthrosc Tech. 2014;3:e7–11.CrossRef
21.
Li J, Li ZL, Zhang H, Su XZ, Wang KT, Yang YM. Long-term outcome of multiple small-diameter drilling decompression combined with hip arthroscopy versus drilling alone for early avascular necrosis of the femoral head. Chin Med J (Engl). 2017;130:1435–40.CrossRef
22.
Govaers K, Meermans G, Bortier H, Londers J. Endoscopically assisted core decompression in avascular necrosis of the femoral head. Acta Orthop Belg. 2009;75:631–6.PubMed
23.
Ellenrieder M, Tischer T, Kreuz PC, Fröhlich S, Fritsche A, Mittelmeier W. Arthroskopisch gestützte Behandlung der aseptischen Hüftkopfnekrose. Oper Orthop Traumatol. 2013;25:85–94.CrossRef
24.
Mukisi-Mukaza M, Manicom O, Alexis C, Bashoun K, Donkerwolcke M, Burny F. Treatment of sickle cell disease’s hip necrosis by core decompression: a prospective case-control study. Orthop Traumatol Surg Res. 2009;95:498–504.CrossRef
25.
Yang S, Wu X, Xu W, Ye S, Liu X, Liu X. Structural augmentation with biomaterial-loaded allograft threaded cage for the treatment of femoral head osteonecrosis. J Arthroplast. 2010;25:1223–30.CrossRef
26.
Neumayr LD, Aguilar C, Earles AN, Jergesen HE, Haberkern CM, Kammen BF, et al. Physical Therapy Alone Compared with Core Decompression and Physical Therapy for Femoral Head Osteonecrosis in Sickle Cell Disease Results of a Multicenter study at a Mean of Three Years After Treatmemt. J Bone Jt Surg. 2006;88–A:2573–82.CrossRef
27.
Kang P, Pei F, Shen B, Zhou Z, Yang J. Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study. Jt Bone Spine. 2012;79:67–72.CrossRef
28.
Poultsides LA, Bedi A, Kelly BT. An algorithmic approach to mechanical hip pain. HSS J. 2012;8:213–24.CrossRef
29.
Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg Am. 1999;81:200–9.CrossRef
30.
McCarthy J, Puri L, Barsoum W, Lee J-A, Laker M, Cooke P. Articular cartilage changes in avascular necrosis: an arthroscopic evaluation. Clin Orthop Relat Res. 2003:64–70.CrossRef
Metadata
Title
Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5 year follow-up
Authors
Mark R. Nazal
Ali Parsa
Scott D. Martin
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2853-0

Other articles of this Issue 1/2019

BMC Musculoskeletal Disorders 1/2019 Go to the issue

Research article

Positive recovery for low-risk injuries screened by the short form - Örebro musculoskeletal pain screening questionnaire following road traffic injury: evidence from an inception cohort study in New South Wales, Australia

Research article

Reliability and validity of knee extensor strength measurements using a portable dynamometer anchoring system in a supine position

Research article

Developing strategic priorities in osteoarthritis research: Proceedings and recommendations arising from the 2017 Australian Osteoarthritis Summit

Research article

Decision-making, therapy, and outcome in lateral compression fractures of the pelvis – analysis of a single center treatment

Research article

Risk factors for pulmonary complications after posterior spinal instrumentation and fusion in the treatment of congenital scoliosis: a case-control study

Research article

Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study