Abstract
Purpose: Osteonecrosis of the femoral head (ONFH) is common in skeletally immature patients. The management of ONFH is controversial, with limited evidence and unpredictable results. This study systematically reviewed the current operative modalities and clinical outcomes of surgical management for ONFH in skeletally immature patients. Methods: The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in October 2021. All the published clinical studies reporting data concerning the surgical management of ONFH in skeletally immature patients were included. Results: This review included 122 patients (127 hips). 38.2% (46 of 122) were female. The mean age of the patients was 14.2 ± 2.3 years. The mean duration of the follow-up was 55.3 ± 19.6 months. The Harris Hip Score improved from 68.8 ± 11.9 at baseline to 90.5 ± 6.5 at last follow-up (p < 0.0001). Femoral head collapse and secondary hip degeneration were the most common complications. Conclusion: Several surgical techniques are available and effective for the management of ONFH in skeletally immature patients. This study evidenced high heterogeneity of the surgical procedures and eligibility criteria. Further high-quality investigations are required to establish proper indications and surgical modalities.
Highlights
Osteonecrosis of the femoral head (ONFH) is a disabling condition which leads to progressive pain, deformity, and early-onset osteoarthritis [1,2]
This study systematically reviewed the current available evidence on the surgical management of ONFH in skeletally immature patients, focusing on techniques, efficacy, and the safety profile
Irrespective of the surgical technique, the mean Harris Hip Score (HHS) improved from 68.8 ± 11.9 at baseline to 90.5 ± 6.5 at last follow-up (+21.7; 95% CI 20.06 to 23.33; p < 0.0001)
Summary
Osteonecrosis of the femoral head (ONFH) is a disabling condition which leads to progressive pain, deformity, and early-onset osteoarthritis [1,2]. The growth plate acts as a barrier for the intraosseous blood vessels, and femoral head vascularisation is guaranteed by the lateral epiphyseal vessels [3,4,5]. Once bone maturity has been reached, the lateral epiphyseal vessels, the vessels of the metaphysis, epiphysis, and round ligament of the femur anastomose [3,4,5,6]. The aetiology of ONFH can be traumatic and atraumatic [7]. In traumatic ONFH, a fracture may cause an interruption of the blood supply to the femoral head [8]. The management of ONFH in skeletally immature patients is controversial, with limited evidence and unpredictable results [24]. This study systematically reviewed the current available evidence on the surgical management of ONFH in skeletally immature patients, focusing on techniques, efficacy, and the safety profile
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