A variety of surgical therapies have been investigated in an attempt to halt the progression of the disease. Surgical therapies include core decompression [6,7] to relieve compression caused by interstitial edema and improve vascularity. Core decompression procedures have been performed alone, or with various forms of vascularized bone grafting, electrical stimulation, and other adjuvant therapies.
Avascular Necrosis - Physiopedia
We present a case of early osteonecrosis of the hip Ficat stage II treated by core decompression and followed up for close to 12 months. To prevent the mechanical failure of the subchondral bone and articular collapse, we used cancellous allograft soaked in patients own blood impacted up the core decompressing channel and utilized an absorbable Interference Screw to hold the graft in place. Theory being to strengthen structural mechanics of the femoral head, provide structural support of articular cartilage bring in osteoblasts and cell mediators whilst decompressing or coring out the devitalized bone and encourage new bone formation.
A year old female was admitted with symptoms of joint pain of 1 year duration in both hips. The left was involved more than the right. The hip pain was so intense the patient could not carry on her routine duties. Her past medical history revealed a long history of Bronchial Asthma attacks requiring high dose of prednisone.
Clinical evaluation minimal restriction of hip joint movement especially internal rotation. Plain radiographs of the pelvis were normal with Bilateral femoral head avascular necrosis is present with no collapse on the left hip Figure 1 , whereas an MRI scan revealed the avascular necrosis involves an area measuring 3.
There is mild edema in the left femoral head and neck. No subchondral bone depression identified overlying the avascular necrosis at the left hip. Patient was thereafter counseled and prepared for surgery. DHS core reamer was placed over the guide pin and this was drilled to within 5 mm of subchondral bone. Bone graft was inserted into the defect just lateral to the sclerotic bone defect visualized on fluoroscopy.
Then we inserted a 9 x 25 mm bio absorbable interference screw into the neck containing the bone graft Figure 2. Immediate postoperative period was uneventful and the patient was mobilized non -weight bearing and was discharged on crutches. Subsequent follow up over the twelve month has been uneventful Figure 3. She reported a marked improvement in her pain and function. In her clinic fellow up, x-ray Figure 4 showed a slight deterioration from before, but there seems to be some consolidation and there has been no further collapse in view of her clinical presentation [Figure 5,6].
She did well for almost 18 months then she start to have pain in her left hip with limited activity. She underwent total hip replacement after 2 years from core decompression. Intra operative finding showed mild flattening of femoral head at weight bearing area without significant collapse [Figure 7,8].
Core decompression was described by Arlet and Ficat in . By , they had performed more than cases.
When properly done, this procedure has minimal side effects. Patients are often restricted to partial weight bearing crutches or walker for 6 weeks following the procedure in order to reduce the risk of the hip bone breaking from the drill holes in the bone.
The results vary depending on the size of the area of dead bone and the stage of the disease. Total Hip Replacement Once the hip reaches later stages Stage 3 and Stage 4 total hip replacement is the treatment of choice in most cases. Further information can be found on Total Hip Replacements on this website.
Hip , Knee , Orthopaedic Oncology. Hip , Knee. Hip , Sports Medicine. Symptoms Symptoms of avascular necrosis can be variable and often times there is no pain at first. Causes The causes of avascular necrosis are not completely understood, but it appears to be related to an interruption in blood flow to the femoral ball. Treatment Non-operative treatment Non-operative management may consist of protective weight-bearing namely, partial weight-bearing with crutches for six weeks then re-evaluation.
Core Decompression Core decompression is a procedure used for treating early stage avascular necrosis. Related Specialties Hip.
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