Top

Journal of Orthopaedic Surgery and Research

Published in:

01-12-2020 | Osteonecrosis | Research article

Results of advanced core decompression in patients with osteonecrosis of the femoral head depending on age and sex—a prospective cohort study

Authors: Sebastian Serong, Marcel Haversath, Tjark Tassemeier, Florian Dittrich, Stefan Landgraeber

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2020

Abstract

Background

Core decompression is a common surgical technique to treat osteonecrosis of the femoral head. The aim of this study is to evaluate the effect of the parameters “age” and “sex” on the outcome of this type of treatment.

Methods

A prospective cohort study was performed. Eighty-six osteonecrotic hips with a mean follow-up of 32.5 months (± 24.8) after advanced core decompression were analysed regarding age- and sex-dependent treatment failure. Additionally, the modified Harris Hip Score and Numeric Rating Scale were compared regarding the parameters age and sex.

Results

The mean hip survival of the male participants was 51.3 months (39.4% treatment failure), whereas females presented a longer, thus not significant, mean survival of 61.4 months (30% therapy failure; p = 0.48). The further evaluation revealed significantly better survival in the patients aged < 40 years (mean survival 66.09 months, 16% treatment failure) in comparison to those aged ≥ 40 years (mean survival 50.14 months, 46% therapy failure; p = 0.03). The modified Harris Hip Score and Numeric Rating Scale results of patients whose treatment did not fail during the study period were similar, irrespective of the patient’s sex or age.

Conclusions

The study shows that the number of therapy failures is significantly higher in older patients, with 40 years of age marking the borderline. Patients’ sex does not seem to affect the outcome of treatment, and postoperative clinical scores appear to be identical with individuals not affected by therapy failure. Since age and sex are unalterable parameters, the study helps to provide valuable predictions regarding the chances of long-term hip survival after treatment of osteonecrosis.

Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459–74.CrossRef

Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med. 1992;326:1473–9. https://doi.org/10.1056/NEJM199205283262206.CrossRefPubMed

Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update. J Bone Joint Surg Am. 2015;97:1604–27. https://doi.org/10.2106/JBJS.O.00071.CrossRefPubMed

Seamon J, Keller T, Saleh J, Cui Q. The pathogenesis of nontraumatic osteonecrosis. Arthritis. 2012;2012:601763. https://doi.org/10.1155/2012/601763.CrossRefPubMedPubMedCentral

Kang JS, Park S, Song JH, Jung YY, Cho MR, Rhyu KH. Prevalence of osteonecrosis of the femoral head: A nationwide epidemiologic analysis in Korea. J Arthroplasty. 2009;24:1178–83. https://doi.org/10.1016/j.arth.2009.05.022.CrossRefPubMed

Fukushima W, Fujioka M, Kubo T, Tamakoshi A, Nagai M, Hirota Y. Nationwide epidemiologic survey of idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res. 2010;468:2715–24. https://doi.org/10.1007/s11999-010-1292-x.CrossRefPubMedPubMedCentral

Camporesi E, Vezzani G, Zanon V, Manelli D, Enten G, Quartesan S, Bosco G. Review on hyperbaric oxygen treatment in femoral head necrosis. Undersea Hyperb Med. 2017;44:497–508.CrossRef

Nakamura J, Harada Y, Oinuma K, Iida S, Kishida S, Takahashi K. Spontaneous repair of asymptomatic osteonecrosis associated with corticosteroid therapy in systemic lupus erythematosus: 10-year minimum follow-up with MRI. Lupus. 2010;19:1307–14. https://doi.org/10.1177/0961203310372951.CrossRefPubMed

Lee Y-K, Ha Y-C, Cho YJ, Suh KT, Kim S-Y, Won Y-Y, et al. Does zoledronate prevent femoral head collapse from osteonecrosis? A prospective, randomized, open-label, multicenter study. J Bone Joint Surg Am. 2015;97:1142–8. https://doi.org/10.2106/JBJS.N.01157.CrossRefPubMed

10.

Disch AC, Matziolis G, Perka C. The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost. J Bone Joint Surg Br. 2005;87:560–4. https://doi.org/10.1302/0301-620X.87B4.15658.CrossRefPubMed

11.

Glueck CJ, Freiberg RA, Sieve L, Wang P. Enoxaparin prevents progression of stages I and II osteonecrosis of the hip. Clin Orthop Relat Res. 2005:164–70. https://doi.org/10.1097/01.blo.0000157539.67567.03.

12.

Lai K-A, Shen W-J, Yang C-Y, Shao C-J, Hsu J-T, Lin R-M. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am. 2005;87:2155–9. https://doi.org/10.2106/JBJS.D.02959.CrossRefPubMed

13.

Vulpiani MC, Vetrano M, Trischitta D, Scarcello L, Chizzi F, Argento G, et al. Extracorporeal shock wave therapy in early osteonecrosis of the femoral head: prospective clinical study with long-term follow-up. Arch Orthop Trauma Surg. 2012;132:499–508. https://doi.org/10.1007/s00402-011-1444-9.CrossRefPubMed

14.

Xie K, Mao Y, Qu X, Dai K, Jia Q, Zhu Z, Yan M. High-energy extracorporeal shock wave therapy for nontraumatic osteonecrosis of the femoral head. J Orthop Surg Res. 2018;13:25. https://doi.org/10.1186/s13018-017-0705-x.CrossRefPubMedPubMedCentral

15.

Wang C-J, Huang C-C, Wang J-W, Wong T, Yang Y-J. Long-term results of extracorporeal shockwave therapy and core decompression in osteonecrosis of the femoral head with eight- to nine-year follow-up. Biomed J. 2012;35:481–5. https://doi.org/10.4103/2319-4170.104413.CrossRefPubMed

16.

Lieberman JR, Conduah A, Urist MR. Treatment of osteonecrosis of the femoral head with core decompression and human bone morphogenetic protein. Clin Orthop Relat Res. 2004:139–45.

17.

Landgraeber S, Theysohn JM, Classen T, Jäger M, Warwas S, Hohn H-P, Kowalczyk W. Advanced core decompression, a new treatment option of avascular necrosis of the femoral head--a first follow-up. J Tissue Eng Regen Med. 2013;7:893–900. https://doi.org/10.1002/term.1481.CrossRefPubMed

18.

Liu D, Chen Q, Chen Y, Liu Y. Long-term follow-up of early-middle stage avascular necrosis of femoral head with core decompression and bone grafting. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012;26:1165–8.PubMed

19.

Rajagopal M, Balch Samora J, Ellis TJ. Efficacy of core decompression as treatment for osteonecrosis of the hip: a systematic review. Hip Int. 2012;22:489–93. https://doi.org/10.5301/HIP.2012.9748.CrossRefPubMed

20.

Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br. 1995;77:34–41.CrossRef

21.

Classen T, Warwas S, Jäger M, Landgraeber S. Two-year follow-up after advanced core decompression. J Tissue Eng Regen Med. 2017;11:1308–14. https://doi.org/10.1002/term.2056.CrossRefPubMed

22.

Serong S, Haversath M, Jäger M, Landgraeber S. Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head. J Tissue Eng Regen Med. 2019. https://doi.org/10.1002/term.2794.

23.

Shimizu J, Okazaki S, Nagoya S, Takahashi N, Kanaya K, Mizuo K, et al. Susceptibility of males, but not females to developing femoral head osteonecrosis in response to alcohol consumption. PLoS One. 2016;11:e0165490. https://doi.org/10.1371/journal.pone.0165490.CrossRefPubMedPubMedCentral

24.

Gardeniers JWM, Gosling-Gardeniers AC, Rijnen WHC. The ARCO staging system: generation and evolution since 1991. In: Osteonecrosis: Springer; 2014. p. 215–8.

25.

Kumar P, Sen R, Aggarwal S, Agarwal S, Rajnish RK. Reliability of modified Harris Hip Score as a tool for outcome evaluation of total hip replacements in Indian population. J Clin Orthop Trauma. 2019;10:128–30. https://doi.org/10.1016/j.jcot.2017.11.019.CrossRefPubMed

26.

Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798–804. https://doi.org/10.1111/j.1365-2702.2005.01121.x.CrossRefPubMed

27.

Landgraeber S, Warwas S, Claßen T, Jäger M. Modifications to advanced core decompression for treatment of avascular necrosis of the femoral head. BMC Musculoskelet Disord. 2017;18:479. https://doi.org/10.1186/s12891-017-1811-y.CrossRefPubMedPubMedCentral

28.

Drescher W, Pufe T, Smeets R, Eisenhart-Rothe RV, Jäger M, Tingart M. Hüftkopfnekrose - Diagnostik und Differenzialtherapie. Z Orthop Unfall. 2011;149:231–40; quiz 241-2. https://doi.org/10.1055/s-0030-1270984.CrossRefPubMed

29.

Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–60.CrossRef

30.

Tingart M, Beckmann J, Opolka A, Matsuura M, Wiech O, Grifka J, Grässel S. Influence of factors regulating bone formation and remodeling on bone quality in osteonecrosis of the femoral head. Calcified Tissue International. 2008;82:300–8. https://doi.org/10.1007/s00223-008-9111-z.CrossRefPubMed

31.

Karsenty G. How many factors are required to remodel bone? Nat Med. 2000;6:970–1. https://doi.org/10.1038/79655.CrossRefPubMed

32.

Li X, Cao X. BMP signaling and skeletogenesis. Ann N Y Acad Sci. 2006;1068:26–40. https://doi.org/10.1196/annals.1346.006.CrossRefPubMed

33.

Durnez A, Paternotte S, Fechtenbaum J, Landewé RBM, Dougados M, Roux C, Briot K. Increase in bone density in patients with spondyloarthritis during anti-tumor necrosis factor therapy: 6-year followup study. J Rheumatol. 2013;40:1712–8.CrossRef

34.

Lacey DL, Timms E, Tan HL, Kelley MJ, Dunstan CR, Burgess T, et al. Osteoprotegerin ligand is a cytokine that regulates osteoclast differentiation and activation. Cell. 1998;93:165–76.CrossRef

35.

Hak DJ, Fitzpatrick D, Bishop JA, Marsh JL, Tilp S, Schnettler R, et al. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury. 2014;45(Suppl 2):S3–7. https://doi.org/10.1016/j.injury.2014.04.002.CrossRefPubMed

36.

Nandra R, Grover L, Porter K. Fracture non-union epidemiology and treatment. Trauma. 2016;18:3–11.CrossRef

37.

Robinson CM, Royds M, Abraham A, McQueen MM, Court-Brown CM, Christie J. Refractures in patients at least forty-five years old. a prospective analysis of twenty-two thousand and sixty patients. J Bone Joint Surg Am. 2002;84-A:1528–33.CrossRef

38.

Gruber R, Koch H, Doll BA, Tegtmeier F, Einhorn TA, Hollinger JO. Fracture healing in the elderly patient. Exp Gerontol. 2006;41:1080–93. https://doi.org/10.1016/j.exger.2006.09.008.CrossRefPubMed

39.

D'Ippolito G, Schiller PC, Ricordi C, Roos BA, Howard GA. Age-related osteogenic potential of mesenchymal stromal stem cells from human vertebral bone marrow. J Bone Miner Res. 1999;14:1115–22. https://doi.org/10.1359/jbmr.1999.14.7.1115.CrossRefPubMed

40.

Sadile F, Bernasconi A, Carbone F, Lintz F, Mansueto G. Histological fibrosis may predict the failure of core decompression in the treatment of osteonecrosis of the femoral head. Int J Surg. 2017;44:303–8. https://doi.org/10.1016/j.ijsu.2017.06.079.CrossRefPubMed

41.

Matthews C, Gorenne I, Scott S, Figg N, Kirkpatrick P, Ritchie A, et al. Vascular smooth muscle cells undergo telomere-based senescence in human atherosclerosis: effects of telomerase and oxidative stress. Circ Res. 2006;99:156–64.CrossRef

42.

Mistriotis P, Andreadis ST. Vascular aging: molecular mechanisms and potential treatments for vascular rejuvenation. Ageing Res Rev. 2017;37:94–116. https://doi.org/10.1016/j.arr.2017.05.006.CrossRefPubMed

43.

Carrington JL. Aging bone and cartilage: cross-cutting issues. Biochem Biophys Res Commun. 2005;328:700–8. https://doi.org/10.1016/j.bbrc.2004.12.041.CrossRefPubMed

44.

Ha Y-C, Kim HJ, Kim S-Y, Kim K-C, Lee Y-K, Koo K-H. Effects of age and body mass index on the results of transtrochanteric rotational osteotomy for femoral head osteonecrosis. J Bone Joint Surg Am. 2010;92:314–21. https://doi.org/10.2106/JBJS.H.01020.CrossRefPubMed

45.

Sadile F, Bernasconi A, Russo S, Maffulli N. Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis. Br Med Bull. 2016;118:33–49. https://doi.org/10.1093/bmb/ldw010.CrossRefPubMedPubMedCentral

Title: Results of advanced core decompression in patients with osteonecrosis of the femoral head depending on age and sex—a prospective cohort study
Authors: Sebastian Serong
Marcel Haversath
Tjark Tassemeier
Florian Dittrich
Stefan Landgraeber
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Osteonecrosis
Osteonecrosis of the Femoral Head
Core Decompression
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2020
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-020-01643-4

At a glance: The STEP trials

Springer Medicine

Results of advanced core decompression in patients with osteonecrosis of the femoral head depending on age and sex—a prospective cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Angiotensin II blockade had no effect on range of motion after total knee arthroplasty: a retrospective review

Outcome of osteofibrous dysplasia-like versus classic adamantinoma of long bones: a single-institution experience

The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection

Association between breastfeeding and osteoporotic hip fracture in women: a dose-response meta-analysis

Transosseous versus transmuscular repair of the posterior soft tissue in primary hip arthroplasty: a meta-analysis

Correction of marked sagittal deformity with circumferential minimally invasive surgery using oblique lateral interbody fusion in adult spinal deformity