Abstract
BackgroundCore decompression (CD) is an important method for the treatment of osteonecrosis of the femoral head (ONFH). Few articles investigate the influence of core decompression on outcomes of ONFH. This study was carried out to observe the safety and effectiveness of core decompression in the treatment of ONFH.MethodsA comprehensive literature search of databases including PubMed, Embase, and Cochrane Library was performed to collect the related studies. The medical subject headings used were “femur head necrosis” and “Core decompression.” The relevant words in title or abstract included but not limited to “Osteonecrosis of the Femoral Head,” “femoral head necrosis,” “avascular necrosis of femoral head,” and “ischemic necrosis of femoral head.” The methodological index for nonrandomized studies was adopted for assessing the studies included in this review.ResultsThirty-two studies included 1865 patients (2441 hips). Twenty-one studies (1301 hips) using Ficat staging standard, 7 studies (338hips) using Association Research Circulation Osseous (ARCO) staging standard, and University of Pennsylvania system for staging avascular necrosis (UPSS) staging criteria for 4 studies (802 hips). All the studies recorded the treatment, 22 studies (1379 hips) were treated with core decompression (CD) alone, and 7 studies (565 hips) were treated with core decompression combined with autologous bone (CD Autologous bone). Nine subjects (497 hips) were treated with core decompression combined with autologous bone marrow (CD Marrow). Twenty-seven studies (2120 hips) documented the number of conversion to total hip replacement (THA), and 26 studies (1752hips) documented the number of radiographic progression (RP). Twenty-one studies recorded the types of complications and the number of cases, a total of 69 cases. The random-effect model was used for meta-analysis, and the results showed that the overall success rate was 65%. The rate of success showed significant difference on the outcomes of different stages. The rate of success, conversion to THA, and radiographic progression showed significant difference on the outcomes of ONFH using different treatments.ConclusionsCore decompression is an effective and safe method of treating ONFH. The combined use of autologous bone or bone marrow can increase the success rate. For advanced femoral head necrosis, the use of CD should be cautious. High-quality randomized controlled trials and prospective studies will be necessary to clarify the effects of different etiology factors, treatments, and postoperative rehabilitation. Until then, the surgeon can choose core decompression to treat ONFH depending on the patient’s condition.Level of evidenceI Meta-analysis
Highlights
Osteonecrosis of the femoral head (ONFH) is interrupted or damaged by the blood supply to the femoral head, causing death and subsequent repair of bone cells and bone marrow components, which in turn leads to structural changes in the femoral head and collapse of the femoral head, causing joint pain and dysfunction in patients, and the disease is difficult to heal [1–3]
Another study confirmed that Core decompression (CD) combined with autologous bone marrow stem cells has achieved good results in early ONFH patients [7]
Through the check processing of EndNote software, it was found that 509 articles were duplicated, and the remaining 408 articles of the title and abstract deletion of the literature were not in conformity with the remaining 63 articles after inclusion of the exclusion criteria
Summary
Osteonecrosis of the femoral head (ONFH) is interrupted or damaged by the blood supply to the femoral head, causing death and subsequent repair of bone cells and bone marrow components, which in turn leads to structural changes in the femoral head and collapse of the femoral head, causing joint pain and dysfunction in patients, and the disease is difficult to heal [1–3]. A study confirms that CD combined with cytotherapy is a relatively good treatment for reducing the failure rate of early and mid-term ONFH patients [6]. Another study confirmed that CD combined with autologous bone marrow stem cells has achieved good results in early ONFH patients [7]. Core decompression (CD) is an important method for the treatment of osteonecrosis of the femoral head (ONFH).
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