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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

19.01.2023 | Orthopaedic Surgery

Avascular necrosis of the femoral head: three-dimensional measurement of drilling precision reveals high accuracy and no difference between fluoroscopically controlled core decompression and cancellous bone grafting

verfasst von: Michael Woerner, Korbinian Voelkl, Felix Ferner, Markus Weber, Tobias Renkawitz, Joachim Grifka, Benjamin Craiovan

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 8/2023

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Abstract

Introduction

Avascular osteonecrosis of the femoral head (AVN) is a widespread disease affecting mostly young and active people, often exacerbating in progressive stages, ending in joint replacement. The most common joint preserving operative therapy for early stages is core decompression (CD), optional with cancellous bone grafting (CBG). For success it is vital that the necrotic area is hit and the sclerotic rim is broken by drilling into the defect zone to relieve intraosseous pressure. The aim of this study was to investigate if both techniques are precise enough to hit the center of the necrosis and if there is a difference in precision between drilling with small pins (CD) and the trephine (CBG).

Patients and methods

10 patients underwent CD, 12 patients CBG with conventional C-arm imaging. Postoperatively 3D MRI reconstructions of the necrotic area and the drilling channels were compared. The deviation of the drilling channel from the center of the necrotic area was measured. PROMs (HHS, HOOS, EQ-5D, SF-36) were evaluated to compare the clinical success of these procedures.

Results

Neither with CD nor with CBG the defect zone was missed. The drilling precision of both procedures did not differ significantly: distance to center 3.58 mm for CD (range 0.0–14.06, SD 4.2) versus 3.91 mm for CBG (range 0.0–15.27, SD 4.7). PROMs showed no significant difference.

Conclusion

Concerning the most important difference between the two procedures—the surgical higher demanding technique of CBG—we suggest applying the less invasive technique of CD alone.

Lieberman MR, Bery DJ, Mont MA, Aaron RK (2002) Osteonecrosis of the hip: management in the twenty-first century. J Bone Joint Surg 52:834–841CrossRef

Koo KH, Lee JS, Lee YS, Kim KJ, Yoo JJ, Kim HJ (2006) Endothelial nitric oxide synthase gene polymorphisms in patients with nontraumatic femoral head osteonecrosis. J Orthop Res 24:1722–1728CrossRefPubMed

Rader C (2007) Transient osteoporosis and osteonecrosis of the femoral head. Risk factors, classification and differential diagnosis. Orthopade 36:423–429CrossRefPubMed

Houdek MT, Wyles CC, Martin JR, Sierra RJ (2014) Stem cell treatment for avascular necrosis of the femoral head: current perspectives. Stem Cells Cloning 7:65–70PubMedPubMedCentral

Wang Y, Li Y, Mao K (2003) Alcohol-induced adipogenesis in bone and marrow: a possible mechanism for osteonecrosis. Clin Orthop Relat Res 410:213–214CrossRef

Mont MA, Jones LC, Hungerford DS (2006) Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg 88:1117–1127PubMed

Lee MS, Hsieh PH, Shih CH, Wang CJ (2010) Non-traumatic osteonecrosis of the femoral head – from clinical to bench. Chang Gung Med J 33:351–360PubMed

Li Y, Yue-Bai L, Yi-Sheng Y (2006) Dexamethasone-induced adipogenesis stromal cell cultures: mechanism of steroid-induced osteonecrosis. Chinese Med J 119:581–588CrossRef

Lukoschek M, Simank HG, Brocai D, Strauch K (1999) Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis. Int Orthop 23:154–159CrossRefPubMedPubMedCentral

10.

Adekile A, Haider M, Marouf R (2005) HLA-DRB1 alleles in Hb SS patients with avascular necrosis of the femoral head. Am J Hematol 79:8–10CrossRefPubMed

11.

Craiovan B, Baier C, Grifka J, Götz J, Schaumburger J, Beckmann J (2013) Bone marrow edema syndrome. Orthopade 42:191–204CrossRefPubMed

12.

Kramer J, Scheurecker G, Scheurecker A, Stöger A, Huber A, Hofmann S (2009) Femoral head necrosis. Radiologe 49:410–418CrossRefPubMed

13.

Wang CJ, Wang FS, Huang CC, Yang KD, Weng LH, Huang HY (2005) Treatment for osteonecrosis of femoral head: comparison of extracorporeal shock waves with core decompression and bone grafting. J Bone Joint Surg 87:2380–2387PubMed

14.

Aigner N, Petje G, Schneider W, Meizer R, Kotsaris S, Knahrl K et al (2005) Bone marrow edema syndrome of the femoral head: treatment with the prostacyclin analogue iloprost An MRI-controlled study. Wien Klin Wochenschr 117:130–135CrossRefPubMed

15.

Rajpura A, Wright A, Board T (2011) Medical management of osteonecrosis of the hip: a review. Hip Int 21:385–392CrossRefPubMed

16.

Li X, Xu X, Wu W (2014) Comparison of bone marrow mesenchymal stem cells and core decompression in treatment of osteonecrosis of the femoral head: a meta-analysis. Int J Clin Exp Pathol 7:5024–5030PubMedPubMedCentral

17.

Roth A, Beckmann J, Bohndorf K, Fischer A, Heiss C, Kenn W et al (2016) S3-Guideline non-traumatic adult femoral head necrosis. Arch Orthop Trauma Surg 136:165–174CrossRefPubMed

18.

Adrian F, Deepak B, Riyaz J, David H (1994) Long term results of core decompression for ischemic osteonecrosis of the femoral head. J Bone Joint Surg 76:42–49

19.

Simank HG, Brocai DR, Strauch K, Lukoschek M (1999) Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis. Int Orthop 23:154–159CrossRefPubMedPubMedCentral

20.

Rocchi M, Del Piccolo N, Mazzotta A, Giavaresi G, Fini M et al (2020) Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up. Hip Int 30:3–12CrossRefPubMed

21.

Hernigou P, Gerber D, Auregan JC (2020) Knee osteonecrosis: cell therapy with computer-assisted navigation. Surg Technol Int 36:281–287PubMed

22.

Martinot P, Dartus J, Justo A, Riouach H, Cremer P et al (2020) Does augmented core decompression decrease the rate of collapse and improve survival of femoral head avascular necrosis? Case-control study comparing 184 augmented core decompressions to 79 standard core decompressions with a minimum 2 years’ follow-up. Orthop Traumatol Surg Res 106:1561–1568CrossRefPubMed

23.

Kang JS, Suh YJ, Moon K, Park JS, Roh TH et al (2018) Clinical efficiency of bone marrow mesenchymal stem cell implantation for osteonecrosis of the femoral head: a matched pair control study with simple core decompression. Stem Cell Res Ther 9:274CrossRefPubMedPubMedCentral

24.

Beckmann J, Goetz J, Baethis H, Kalteis T, Grifka J, Perlick L (2006) Precision of computer-assisted core decompression drilling of the femoral head. Arch Orthop Trauma Surg 126:374–379CrossRefPubMed

25.

Learmonth LD, Maloon S, Dall G (1990) Core decompression for early atraumatic osteonecrosis of the femoral head. J Bone Joint Surg 72:387–390CrossRef

26.

Beckmann J, Tingart M, Perlick L, Lüring C, Grifka J, Anders S (2007) Navigated drilling for femoral head necrosis experimental and clinical results. Orthopade 36(4):58–465

27.

Ficat R (1985) Idiopathic bone necrosis of the femoral head. J Bone Joint Surg 67:3–9CrossRef

28.

Beckmann J, Schmidt T, Schaumburger J, Rath B, Lüring C, Tingart M et al (2012) Infusion, core decompression, or infusion following core decompression in the treatment of bone edema syndrome and early avascular osteonecrosis of the femoral head. Rheumatol Int 33:1561–1565CrossRefPubMed

29.

Sallam A, Imam M, Salama K, Mohamed O (2017) Inverted femoral head graft versus standard core decompression in nontraumatic hip osteonecrosis at minimum 3 years follow-up. Hip Int 27:74–81CrossRefPubMed

30.

Koo KH, Ahn I, Kim R, Song HR, Jeong ST, Na JB et al (1999) Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial MR images. Radiology 213:715–722CrossRefPubMed

31.

Tripathy S, Goyal T, Kumar R (2015) Management of femoral head osteonecrosis: current concepts. Indian J Orthop 49:28–45CrossRefPubMedPubMedCentral

32.

Kaushik A, Das A, Cui Q (2012) Osteonecrosis of the femoral head: an update in year 2012. World J Orthop 3:49–57CrossRefPubMedPubMedCentral

Titel: Avascular necrosis of the femoral head: three-dimensional measurement of drilling precision reveals high accuracy and no difference between fluoroscopically controlled core decompression and cancellous bone grafting
verfasst von: Michael Woerner
Korbinian Voelkl
Felix Ferner
Markus Weber
Tobias Renkawitz
Joachim Grifka
Benjamin Craiovan
Publikationsdatum: 19.01.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 8/2023
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04753-2

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Avascular necrosis of the femoral head: three-dimensional measurement of drilling precision reveals high accuracy and no difference between fluoroscopically controlled core decompression and cancellous bone grafting