Avascular necrosis hips: management with core decompression bone graft and bone marrow aspirate concentrate (original) (raw)
Related papers
Journal of Clinical Orthopaedics and Trauma, 2021
Background: Various joint preserving treatments are available for use in Avascular Necrosis of the femoral head. Most of these are effective in the pre-collapse stage of the disease. This review aimed to evaluate the effectiveness of core decompression and Bone Marrow Aspirate Concentrate in various stages of AVN, in modifying the progression of the disease and the need for hip replacement. Material and methods: The Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews reporting guidelines were followed. The literature search was conducted from inception till 2 nd May 2021, on the PUBMED, SCOPUS, and Google Scholar search engines, using "bone marrow aspirate concentrate osteonecrosis femur" and "bmac osteonecrosis femur" as the keywords. In all these studies, Core Decompression with Bone marrow Aspirate concentrate was performed. The evaluation was done based on the progression of osteonecrosis, improvement in functional outcomes and the conversion to total hip arthroplasty. Results: We have analyzed 612 hips from11 studies, based on our inclusion and exclusion criteria. The mean age of the patients was 38.27 years. There was a predominance of males. The grade of AVN ranged from grade 1 to 4. The average follow-up period of the cases ranged from 2 to 12 years (average: 4.38 years). The functional scores were improved in the majority of cases. Radiographic progression occurred in 23.5% of hips, and the Total Hip Arthroplasty was performed in 14.9% of hips. Conclusions: Core decompression with Bone Marrow Aspirate Concentrate in pre-collapse stages of the disease is beneficial in improving the functions scores and for reducing the radiological progression of the disease and need for total hip arthroplasty, in the majority of cases.
Journal of Clinical Orthopaedics and Trauma, 2015
Background: Femoral head is the most common bone affected by avascular necrosis. Core decompression procedure, when done in the initial stages, before collapse, may arrest or reverse the progress of avascular necrosis and thereby may preserve the normal femoral head. Hence, we have analysed the clinical, functional and radiological outcome of core decompression and bone grafting in patients with Osteonecrosis of the femoral head (ONFH) upto stage IIB (Ficat & Arlet). Materials and method: A study was undertaken at our institute from June 2010 to June 2013 wherein 20 patients (28 hips) of ONFH upto grade II B (Ficat & Arlet) were treated with core decompression and the outcomes were studied. Patients were subjected to core decompression of the affected hip. All the patients were operated in lateral position. In 26/28 hips, cancellous grafting was done after harvesting graft from the posterior iliac crest. In 2 patients cortical non-vascularised fibular graft was used. Results: Functional outcome was assessed by Harris hip score, wherein 19 hips (67.85%) had good or excellent outcome; 1 hip (3.57%) had fair out come. However, 8 hips (28.57%) showed poor result. For stage I, 12/13 hips (92.3%) improved, whereas for Stage IIA, 6/11 hips (54.54%) showed improvement and for stage IIB, only 2/4 hips (50%) showed improvement. Less than 25% of the hips required a replacement or salvage procedure. Strict non weight bearing was complied by 23 hips (82.14%), whereas 5 hips (17.85%) were not compliant. If we exclude non compliant patients, our success rate was 92.3% for grade I, 100% for grade IIA and 50% for grade IIB. Conclusion: Core decompression and bone grafting provide satisfactory outcome when patients are carefully selected in early stages of the disease, before the stage of collapse.
International Journal of Orthopaedics Sciences, 2020
Introduction: Osteonecrosis of the hip is an incapacitating disease where the goal of management is to diagnose and treat it early in the pre-collapse stage. Core decompression (CD) is an established modality to treat the pre-collapse stage. We aimed to evaluate the outcome of CD alone versus CD with Bone Marrow Aspirate Concentrate infiltration. Materials and Methods: We conducted a retrospective cum prospective cross sectional randomized study comparing CD and CD + BMAC. Post-operative radiographs were taken and the patient was reviewed every 3 months with radiographs. Harris Hip score (HHS) and Visual Analog Scale (VAS) score were assessed on the follow up. A paired-T test was used for analysis of results. Results: 23 patients (32 hips) were included in which 15 hips were treated in the form of CD+ BMAC and 17 hips treated with CD alone with a mean follow up 14.4 months for the study. There was significantly lowered Harris Hip Score in the Core Decompression group and a significantly lowered VAS score (i.e. reduced pain) in the Core Decompression + BMAC group. As compared to the pre-op Harris hip Score, the follow up HHS increased in 8 of the 15 patients in CD+BMAC group and 2 of the 17 patients in CD group. As compared to the pre-op VAS Score, the follow up VAS reduced in 8 of the 15 patients in CD+BMAC group and 2 of the 17 patients in CD group. Conclusion: Our study concludes that BMAC + CD is a safe, efficient and a less technically demanding modality for the treatment of non-traumatic avascular necrosis of femoral head in pre-collapse stage. BMAC significantly improves the results of Core decompression both functionally and radiologically. Patient satisfaction and pain relief is better than CD alone.
Core decompression and biotechnologies in the treatment of avascular necrosis of the femoral head
EFORT Open Reviews, 2017
Avascular necrosis (AVN) of the femoral head (FH) causes 5% to 12% of total hip arthroplasties (THA). It especially affects active male adults between the third and fifth decades of life. The exact worldwide incidence is unknown. There are only few data related to each country, but most of it relates to the United States. Non-surgical management has a very limited role in the treatment of AVN of the FH and only in its earliest stages. Core decompression (CD) of the hip is the most common procedure used to treat the early stages of AVN of the FH. Recently, surgeons have considered combining CD with autologous bone-marrow cells, demineralised bone matrix or bone morphogenetic proteins or methods of angiogenic potential to enhance bone repair in the FH. Manuscripts were deemed eligible for our review if they evaluated treatment of early stage AVN of the FH with biotechnology implanted via CD. After application of eligibility criteria, we selected 19 reports for final analysis. The prin...
Journal of Hip Preservation Surgery, 2020
Head preserving modalities in avascular necrosis (AVN) hip are variably effective in early stages, and further options that could prevent head distortion and osteoarthritis are needed. Core decompression (CD) is the most commonly used surgery in the early stages of osteonecrosis with variable rates of success. The present review aimed to determine the effectiveness of bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), bone morphogenetic proteins (BMP) or their combination with CD in early stages of AVN hip, prior to collapse of femoral head. Additionally, any newer unexplored modalities were also searched for and ascertained. PubMed and SCOPUS databases were searched for relevant articles in English language describing CD with aforementioned orthobiologics. We analysed a total of 20 studies published between 2011 and 2020. There were 6 retrospective and 14 prospective studies. PRP showed improved survival and functional outcomes; however, with only three studies, t...
The Results Of Core Decompression Treatment In Femoral Head Avascular Necrosis
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2018
The Results of Core Decompression Treatment in Avascular Necrosis of the Femoral Head Objective: Avascular necrosis of the femoral head (AVNFH) is a progressive disease seen in young, active patients, leaving significant disability in the joint when untreated. We retrospectively examined the results of patients with early stage AVNFH who had been operated in our clinic. Methods: In our study, 65 hips of 46 patients were evaluated retrospectively. These patients were evaluated clinically by the Merle d'Aubigné-Postel Score and Harris Hip Score. The patients were radiologically staged according to the criteria by Ficat and Arlet with hip anterior-posterior and lateral graphs and magnetic resonance imaging. Results: The mean follow-up period of the patient group was 73 months, and the mean age of the patients was 35 years. Of these patients, 59% were female and 41% were male; 41% had bilateral and 40% had right hip involvement. One of the patients developed AVNFH while she was pregnant, 7 were idiopathic, and 38 (81%) developed AVNFH due to steroid use. According to the Ficat and Arlet classification, 18 hips were found to be stage 1, 37 hips stage 2, and 9 hips stage 3 during admission. From the etiological point of view, 81% of the patients developed AVNFH while using steroid and 19% had idiopathic AVNFH. As for clinical improvement of the patients, the Harris Hip Score increased from 58 to 90 in idiopathic patients and 55 to 83 among steroid users. The Merle d'Aubigné-Postel classification scores increased from 6 to 15 in the idiopathic group and from 6 to 13 among steroid users. Radiologically, according to the Ficat and Arlet stage, progression was seen in all stages. Of the patients, 38.8% in stage 1, 70.2% in stage 2, and 88.8% in stage 3 showed progression, whereas 20% demonstrated rapid progression and needed total hip prosthesis. All patients who demonstrated progression were on chronic steroid therapy. The mean time to conversion to total hip replacement was 27 months. Conclusion: Osteonecrosis is a disease associated with high morbidity. Early diagnosis can reduce morbidity and improve a patient's quality of life. Core decompression has the effect of stopping the progression of AVNFH in the early (stage 1) stages, although it has a significant and long-term palliative effect in all stages. Most of the young and active patients with AVNFH still do not have any ideal method for treatment today, but core decompression in the early stages has been seen to reduce morbidity. It is a time-saving attempt before the final treatment, which is hip arthroplasty, is performed.
Management of avascular necrosis of femoral head at pre-collapse stage
Indian Journal of Orthopaedics, 2009
In osteonecrosis the success of interventions that forestall or prevent femoral head collapse and maintain hip function would represent a substantial achievement in the treatment of this disease. A review of recent literature regarding bisphosphonate, anticoagulant, and vasodilators and biophysical modalities have demonstrated efÞ cacy in reducing pain and delaying disease progression in early stage osteonecrosis. Though it has been considered still insufÞ cient, to support their routine use in the treatment or prevention of osteonecrosis of the hip. Core decompression with modiÞ cation of technique is still one of the safest and most commonly employed procedures with evidence based success in the pre-collapse stage of AVN of femoral head. The additional use of bone morphogenic protein, and bone marrow stem cells may provide the opportunity to enhance the results of core decompression. At present, the use of large vascularised cortical grafts, the other surgical procedure with high success rate is still not common due to technical difÞ culty in surgery. Likewise osteotomies are also not getting common as arthroplasty is getting more acceptable, so is awaited without any intermediate big surgical interventions.
Management of avascular necrosis of femoral head by core decompression
International Journal of Research in Orthopaedics, 2018
Background: Avascular necrosis (AVN) is defined as cellular death of bone components due to interruption of the blood supply; the bone structures then collapse, resulting in bone destruction, pain, and loss of joint function. The head of femur is the most common bone affected by avascular necrosis. Our aim is to study results of core decompression and bone grafting in avascular necrosis of femoral head.Methods: The present study was performed at Pravara Rural Hospital, a constituent hospital of Rural Medical Collage at Village Loni, Rahta and district: Ahamadnagar. The study includes patients who underwent core decompression and bone grafting in avascular necrosis of femoral head at Department of Orthopaedics, Pravara Rural Hospital from June 2015 to June 2017.Results: In our study majority of the patients belongs to the group of 31-40 years and most of them were males. Male female ratio was 4:1. Out of 20 patients, 6 of them were unilaterally involved rest 14 had bilateral involvem...
F1000Research
Background: Core decompression is a hip preserving surgical procedure that is used to treat avascular necrosis (AVN) of the femoral head. The eventual clinical and radiological outcome following this procedure is varied in literature. Also, the time to a total hip replacement (THR) from the index procedure and the percentage of patients subsequently undergoing a THR is controversial. Furthermore, there are multiple surgical methods along with multiple augmentation techniques and various classification and staging systems described. The purpose of this systematic review, therefore, is to analyse the outcomes following decompression only, excluding any augmentation techniques for non-traumatic AVN of the femoral head. Methods: This protocol is being developed in line with the PRISMA-P guidelines. The search strategy includes articles from Medline, Embase, Google Scholar, CINHAL and Cochrane library. The review and screening will be done by two independent reviewers. Review articles, e...
MVP Journal of Medical Sciences
Osteonecrosis of the femoral head is not a specific diagnostic entity, but rather the final common pathway of a series of derangements that produce a decrease in blood flow, leading to cellular death within the femoral head. It can present with a number of clinical manifestations. The most common complaint is a deep, intermittent, throbbing pain in the groin region which has an insidious onset. In the early stages, prophylactic measures are used to prevent further progression of the disease. When the patient is diagnosed in later stages, the collapse and distortion of the femoral head can be seen, for which a reconstructive procedure is the treatment of choice. The goals of total hip arthroplasty are to relieve pain, to provide motion with stability and to correct deformity so that they are able to return to their normal daily activities. Total hip arthroplasty can be the first treatment of choice. especially in the advanced stages of hip osteonecrosis, or can be reserved as a salvaging procedure when other more conservative treatments fail. Total Hip Arthroplasty is a good modality of treatment for patients with very poor pre-surgical functional scores combined with an excellent long term survival of the cement-less implants.