EVALUATION OF DIFFERENT MODALITIES OF SURGICAL TREATMENT FOR AVASCULAR NECROSIS OF THE FEMORAL HEAD IN BASRAH

Rafid A Yaseen

doi:10.33762/bsurg.2012.54967

Abstract

This prospective study was done in Basrah General Hospital, from June 2009 to December 2011. It included 92 hips in eighty one patients affected clinically and radiologically by femoral head avascular necrosis. They were 50 males and 31 females, mean age 41 years with a range of 15-67 years with stage II-IV of femoral head AVN according to Ficat and Arlet radiological staging system. The aims of this study are; to know the pattern of avascular necrosis of the femoral head, and to evaluate the outcome of the different surgical modalities. Surgery was conducted in form of; group I includes twenty four hips (24.4%) which were treated by core decompression (12 hips =12.2% by multiple small drilling (group I-a); seven patients were satisfied with the result of surgery. Infection was reported in one patient. Twelve hips =12.2% by wide bore drilling "gutter" and bone graft(group I-b); nine patients were satisfied by the result of surgery). Group II includes fifty three hips (54.1%) which were treated by total hip arthroplasty (25=25.5% cemented THR (group II-a); seventeen patients were satisfied with the procedure; Complications were reported in three cases, and 28=28.6% cementlessTHR (group II-b); twenty one patients were satisfied; complications had been encountered in five cases); five patients had bilateral hip surgery. Group III includes twenty one hips (21.4%) which were tackled by Girdlestone (resection arthroplasty); six patients had bilateral hip surgery. Only nine patients were satisfied with this procedure. In conclusion, core decompression surgery in form of wide bore drilling with bone graft is suitable treatment for early stages of avascular necrosis. Total hip replacement is suitable option for AVN in advance stage. Resection arthroplasty still is an option for patients in certain situations (e.g. infection), although the results were less favorable.

Highlights

Osteonecrosis of the femoral head is a challenging disorder often occurring in young patients in the third through fifth decade of life[1]; if left untreated, it leads to complete deterioration of the hip joint[2,3,4].Despite advances in the understanding of the pathogenesis and etiology of this disease, non-traumatic osteonecrosis remains a challenging diagnostic and therapeutic dilemma[5,6]
B.group II: fifty three patients; most of them approached by lateral incision apart from three patients approached by posterior incision and six patients by anterolateral approach
Predisposing factors: A lot of risk factors were contributed to the development of Avascular necrosis (AVN) single or in combination, table IV showed the distribution of patients according to the risk factors in order of frequency

Summary

Introduction

Osteonecrosis of the femoral head is a challenging disorder often occurring in young patients in the third through fifth decade of life[1]; if left untreated, it leads to complete deterioration of the hip joint[2,3,4]. Despite advances in the understanding of the pathogenesis and etiology of this disease, non-traumatic osteonecrosis remains a challenging diagnostic and therapeutic dilemma[5,6]. The natural history of non-traumatic osteonecrosis has been well documented[4,7,8,9,10], and a high rate of progression has been reported when non-operative treatment alone has been used for symptomatic patients[4,8,11,12]. Given the relatively young age at the time of presentation and the poor long-term results that have been reported after total hip arthroplasty in this population of patients, preservation of the joint is recommended for patients who have early-stage disease[13,14,15,16]

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Discussion

Conclusion