Abstract
Background:Core decompression is a hip preserving surgical procedure that is used to treat avascular necrosis (AVN) of the femoral head. The eventual clinical and radiological outcome following this procedure is varied in literature. Also, the time to a total hip replacement (THR) from the index procedure and the percentage of patients subsequently undergoing a THR is controversial. Furthermore, there are multiple surgical methods along with multiple augmentation techniques and various classification and staging systems described. The purpose of this systematic review, therefore, is to analyse the outcomes following decompression only, excluding any augmentation techniques for non-traumatic AVN of the femoral head. Methods:This protocol is being developed in line with the PRISMA-P guidelines. The search strategy includes articles from Medline, Embase, Google Scholar, CINHAL and Cochrane library. The review and screening will be done by two independent reviewers. Review articles, editorials and correspondences will be excluded. Articles including patients with sickle cell disease and with core decompression where augmentation is used will be excluded. The risk of bias and quality of articles will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for the different study designs included. Discussion:This study will be a comprehensive review on all published articles having patients with AVN of the femoral head and undergoing core decompression surgery only. The systematic review will then define the outcomes of the core decompression surgery based on clinical and radiological outcomes. Each outcome will include the different stages within it and finally, the total mean time to THR will be calculated. This will then be followed by assessing the cumulative confidence in evidence from all the data collected using the GRADE tool. Registration:This systematic review is registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42018100596.
Highlights
Osteonecrosis or avascular necrosis (AVN) of the femoral head is a challenging condition that eventually leads, in the majority of cases, to a total hip replacement (THR)1–3
The aetiology is varied and includes multiple conditions that can lead to a reduced blood supply in the femoral head: oral corticosteroids, systemic lupus erythematosus, binge consumption of alcohol, Gaucher disease, sickle cell anaemia, trauma, thrombosis amongst others5
Staging systems for AVN are different across the literature and pose a significant problem in assessing surgical indications and stratifying outcome6
Summary
Osteonecrosis or avascular necrosis (AVN) of the femoral head is a challenging condition that eventually leads, in the majority of cases, to a total hip replacement (THR). Core decompression is a hip preserving surgical procedure that is used to treat avascular necrosis (AVN) of the femoral head. The purpose of this systematic review, is to analyse the outcomes following decompression only, excluding any augmentation techniques for non-traumatic AVN of the femoral head. Articles including patients with sickle cell disease and with core decompression where augmentation is used will be excluded. Discussion: This study will be a comprehensive review on all published articles having patients with AVN of the femoral head and undergoing core decompression surgery only. Each outcome will include the different stages within it and the total mean time to THR will be calculated This will be followed by assessing the cumulative confidence in evidence from all the data collected using the GRADE tool. Registration: This systematic review is registered in the International Prospective Register for Systematic Reviews and Meta-analysis (PROSPERO) under the registration number: CRD42018100596 version 1
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