Core Decompression Of Femoral Head Research Articles

Femoral Head Core Decompression and Bone Marrow Concentrate Injection in Pediatric Sickle-cell Related Avascular Necrosis.

Femoral head avascular necrosis affects 10% to 40% of patients with sickle cell disease (SCD). The purpose of this study was to evaluate the results of femoral head core decompression and bone marrow aspirate concentrate (CD-BMAC) injection in pediatric patients with SCD. Eligible patients were enrolled in this retrospective study of patients undergoing CD-BMAC. Patients with SCD who were younger than 18 at the time of surgery and had >1 year of follow-up were included in this analysis. Hips were staged based on the Ficat system by 2 raters. The visual analog score for pain, hip outcome score, modified Harris hip score, and the University of California, Los Angeles activity score were used as patient-reported outcome measures preoperatively, at 5 to 9 months postoperatively, and final follow-up. Treatment failure was defined as total hip arthroplasty or visual analog score >3 at the final follow-up. Twenty-three hips in 17 patients were included, with a median age at the time of surgery of 15.8 years (interquartile range: 13.1 to 17.8 y). Patients were followed for 4.25 ± 1.7 years. Ten hips showed a 1-stage increase in the Ficat stage at the final follow-up, whereas 11 retained the same stage, and 1 hip had a 1-stage regression. All patient-reported outcome measures showed significant improvement from the preoperative visit to short-term follow-up, but the preoperative to final follow-up improvement was not significant. Six treatment failures were recorded, including 3 total hip arthroplasties and 3 painful hips at the final follow-up. In a multivariate logistic regression model, only skeletal maturity (odds ratio = 16.2, 95% CI: 1.44-183.0, P = 0.024) and femoral head collapse (odds ratio = 12.0, 95% CI: 1.1-130.5, P = 0.041) were significant predictors of treatment failure. In the largest study on pediatric SCD patients undergoing CD-BMAC, we found that CD-BMAC injection offers significant improvement in pain and functional outcomes in the short term, with a very low risk for complications. Skeletal maturity and femoral head collapse were significant predictors of treatment failure. Patients with a collapsed femoral head experienced functional deterioration over time after initial improvement, whereas precollapse hips maintained their functional improvement up to the latest follow-up. Level III, retrospective cohort study.

Multiple hole drilling in osteonecrosis of femoral head- promising and better method of core decompression in Asian population

Introduction: Core decompression of femoral head has been one of the best option for delaying the need for Total Hip Replacement in cases of osteonecrosis of femoral head. It is also the best treatment option in earliest pre-collapse stages of disease. Techniques have been combined with several other adjunctive treatment modalities such as bone grafting and the addition of growth and differentiation factors [7]. Our case series describes the multiple hole drilling in osteonecrosis of femoral head.Materials and Methods: Our series include 46 patients (64 hips), who were diagnosed with osteonecrosis of femoral head of various aetiology. We improvised the conventional decompression technique which usually requires 8mm Michele trephine and DHS reamer with patient in fracture table. In our method, the patient was positioned in supine without need of any fracture table and small incision of less than 1cm was made in lateral aspect of thigh. We used only a single 3.5 mm drill bit and 3-4 holes were drilled into the femoral head under C-arm guidance. We didn’t use any adjunctive. Patients were allowed for partial weight bearing mobilisation with walker assistance for the first month and without any support thereafter.Results: Our case series includes totally 46 patients (64 hips) of Ficat stage I, II and III of osteonecrosis of femoral head. We had a follow up of two years. Patients who were symptomatic and showing oedema in femoral head had better results. Harris hip score was used for assessment. Post operatively patients showed improvement clinically. Only one patient required Total Hip Replacement later. None of the cases reported any perioperative fracture. Conclusion: Core decompression has been evolved the most reliable treatment for osteonecrosis of femoral head, especially for the early stages of necrosis. We have improvised the technique and made it quite simpler, less invasive, safer, and time saving and resulted in less morbidity, comparing to the conventional method of single coring, with better outcome and promising results. Also, considering the narrow width of Asian necks, multiple drill hole technique is more ideal option, as it eliminates the risk of fracture and other risks of single coring technique, and being cost effective too. Thus, multiple hole drilling is the best method of core decompression of femoral head, especially in Asian population.

3D Printed Personalized Guide Plate in the Femoral Head Core Decompression

Objective. To investigate the feasibility of using 3D printed personalized guide plates in core decompression procedures for the treatment of osteonecrosis of the femoral head (ONFH). Methods. The clinical data of 8 patients undergoing femoral head core decompression from January to December 2019 were analyzed retrospectively. Three-dimensional (3D) images of the patients were reconstructed from the CT scan data taken preoperatively. From the data obtained, puncture position, drill hole, and depth were evaluated, and individualized 3D puncture guide plates were designed using Mimics 21.0 software. During the operation, the needle went through the hole of the guide plate, the depth of the drill was controlled, and the obtained bone tissues were sent for pathological evaluation. Intraoperative X-ray and postoperative pathological results were used to evaluate the success of the puncture. Results. The individualized guide plates used for core compression on the 8 patients were well fitted with the anatomic structure of the puncture site, and the direction and depth of the needle insertion were consistent with the preoperative design. The operation time was about 15-22 mins. The position of the decompression tunnel was the same as the designed plate. The postoperative pathology showed necrotic bone tissue. There were no postoperative complications such as infection, bleeding, and fracture. Conclusion. The 3D printed individualized guide plate can simplify core decompression and would make this procedure more accurate, safe, and quick, in addition to obtaining necrotic tissues for pathological examination.

Study on the outcome of patients with aseptic femoral head necrosis treated with percutaneous multiple small-diameter drilling core decompression: a retrospective cohort study based on magnetic resonance imaging and equivalent sphere model analysis

BackgroundAseptic necrosis of the femoral head (ANFH) has a high incidence in the community and causes substantial problems with health as well as economic and social stress. Core decompression is the most commonly used treatment for early ANFH. Although many studies have reported on the efficacy of femoral head core decompression surgery for ANFH, there are still some shortcomings in assessing the severity of femoral head necrosis, the location distribution, and changes in necrotic lesions before and after surgery. Magnetic resonance imaging (MRI) and equivalent sphere model analysis were used to further clarify the clinical efficacy of percutaneous multiple small-diameter drilling core decompression in patients with ANFH.MethodsFrom July 2013 to November 2016, 24 patients (32 cases of the hip joint) with ANFH who underwent percutaneous multiple small-diameter drilling core decompression were selected, and a retrospective analysis was conducted. MRI as well as VAS, OHS-C, and HHS scores were used to evaluate joint function in all patients before and 6, 12, and 24 months after the operation.ResultsTwenty-four months after the operation, 10 hips were amputated. The survival rates of alcoholic femoral head necrosis (AFNH), idiopathic femoral head necrosis (IFHN), and steroid-induced femoral head necrosis (SIFHN) patients at 24 months were 100%, 85.7% (− 2 hips), and 0.0% (− 8 hips), respectively. The MRI and equivalent sphere analysis results revealed that the anterior superior medial quadrant was the area most prone to osteonecrosis, and the posterior superior medial quadrant was the area second most prone to necrosis. After the operation, the average percentage of the AFHN necrosis area in the total volume of the femoral head decreased from 14.5 to 10.3%, and the average percentage of the IFHN necrosis area decreased from 16.3 to 9.2%; however, the average percentage of the necrosis area for SIFHN increased from 30.4 to 33.1%.ConclusionPercutaneous multiple small-diameter drilling core decompression significantly reduced the lesion volume for AFHN and IFHN, but the effect on SIFHN was not good.

A silk-based high impact composite for the core decompression of the femoral head.

Core decompression of the femoral head is a recommended head-conserving strategy for early-stage osteonecrosis of the femoral head. However, no ideal filling material has been found so far. In this study, we fabricated a "solid core-porous coating" composite scaffold, which is a silk fibroin/hydroxypropyl methylcellulose (SF/HPMC) scaffold, by a "two-step" process. The solid core scaffold possesses a sufficient compression modulus (860 MPa) for support, while the porous coating scaffold with controllable pore size and porosity provides a suitable microenvironment for the osteoblast cell to adhere and proliferate. Moreover, the porous coating scaffold was mineralized by adding different contents of hydroxyapatite crystal to further enhance its osteoinductivity, according to the simulated body fluid (SBF) biomineralization assay. To demonstrate the biocompatibility and osteoinductivity of such composite scaffolds, a series of in vitro experiments were performed, indicating the MC3T3-E1 pre-osteoblast cells grew and differentiated well on the mineralized porous coating scaffolds. The mechanical testing results also proved that the mechanical property of the solid core scaffold varied (230-1600 MPa) with different solid contents of SF/HPMC, as expected. Furthermore, the rabbit femoral head core decompression model was adopted and confirmed the excellent mechanical performance of the solid core scaffolds, as well as the satisfied osteoinductivity of the porous coating scaffold, by inserting the composite scaffolds into the bone tunnel in vivo. All of the preliminary results implied that the novel biodegradable composite scaffold has an outstanding prospective for the clinical use of core decompression of the femoral head.

Anesthesia management in a patient with systemic lupus erythematosus and left ventricular thrombus

Systemic lupus erythematosus (SLE) is a complex autoimmune disorder with heterogeneous presentation. We discuss the perioperative management of a female having SLE with left ventricular thrombus who was scheduled for bilateral femoral head core decompression. Warfarin was stopped preoperatively in order to bring down international normalized ratio <1.5 and restarted postoperatively on next day.

Core Decompression by Laser Osteoperforation: A Preliminary Report of New and Minimally Invasive Modality for the Treatment of Avascular Necrosis of the Femoral Head

Introduction: Avascular necrosis (AVN) of the femoral head is a devastating disease that often leads to the destruction of the hip. Core decompression of femoral head is the commonest of all conservative surgical treatments where an 8-10 mm cylindrical core of bone is removed from antero-lateral segment of the femoral head. But it is employed only in early stages of the disease and its results are still of controversial efficacy and most of patients ultimately require total hip arthroplasty. Laser irradiation stimulates the reparative process in the bone and marrow while local hyperthermia produced by the laser vaporizes some of necrotic areas leading to a reduction of the intraosseous pressure which is the fulcrum of AVN regardless of the cause.&#x0D; Objectives: The aim of this experimental study was to evaluate the outcome of core decompression by laser osteoperforation for AVN of the femoral head.&#x0D; Subjects and methods: The study was carried out at the Institute of Laser Surgery and Hospital, Dhaka, Bangladesh which included 62 hips with AVN in 40 patients. Preoperative and Postoperative Clinical assessment and Radiological staging were done using ‘Harris Hip Score (HHS)’ and ‘Ficat and Arlet staging’ respectively. Under spinal anesthesia and Fluoroscopic guidance all hips were subjected to ‘Core decompression by Laser Osteo-perforation’ using 970 nm Diode laser through 18G spinal needle via trans-trochanteric and trans-capital approach.&#x0D; Results: All patients were followed up at intervals of three weeks, three months, six months and then yearly (cases with minimum 3 follow ups were included in this study). According to HHS our results are as : 40.3% - excellent; 21.0% - good; 29.0% - fair; 9.7% - poor. No significant side effects or complications were observed so far.&#x0D; Conclusion: Core decompression by laser osteoperforation has been proven so far to be an effective, safe and minimally invasive treatment modality for AVN of the femoral head.

Core Decompression by Laser Osteoperforation: A Preliminary Report of New and Minimally Invasive Modality for the Treatment of Avascular Necrosis of the Femoral Head

Introduction: Avascular necrosis (AVN) of the femoral head is a devastating disease that often leads to the destruction of the hip. Core decompression of femoral head is the commonest of all conservative surgical treatments where an 8-10 mm cylindrical core of bone is removed from antero-lateral segment of the femoral head. But it is employed only in early stages of the disease and its results are still of controversial efficacy and most of patients ultimately require total hip arthroplasty. Laser irradiation stimulates the reparative process in the bone and marrow while local hyperthermia produced by the laser vaporizes some of necrotic areas leading to a reduction of the intraosseous pressure which is the fulcrum of AVN regardless of the cause. Objectives: The aim of this experimental study was to evaluate the outcome of core decompression by laser osteoperforation for AVN of the femoral head. Subjects and methods: The study was carried out at the Institute of Laser Surgery and Hospital, Dhaka, Bangladesh which included 62 hips with AVN in 40 patients. Preoperative and Postoperative Clinical assessment and Radiological staging were done using 'Harris Hip Score (HHS)' and 'Ficat and Arlet staging' respectively. Under spinal anesthesia and Fluoroscopic guidance all hips were subjected to 'Core decompression by Laser Osteo-perforation' using 970 nm Diode laser through 18G spinal needle via trans-trochanteric and trans-capital approach. Results: All patients were followed up at intervals of three weeks, three months, six months and then yearly (cases with minimum 3 follow ups were included in this study). According to HHS our results are as : 40.3% - excellent; 21.0% - good; 29.0% - fair; 9.7% - poor. No significant side effects or complications were observed so far. Conclusion: Core decompression by laser osteoperforation has been proven so far to be an effective, safe and minimally invasive treatment modality for AVN of the femoral head.

Endoscopic and Arthroscopic Assistance in Femoral Head Core Decompression

Core decompression is a joint-preserving surgery feasible in early-stage avascular necrosis of the femoral head. An arthroscopically/endoscopically aided development of this procedure is presented to overcome some drawbacks of the standard technique. Conventional imaging may underestimate the articular damage; thus a preliminary hip arthroscopy helps to identify those patients with significant joint damage, who might not benefit from the procedure. The standard fluoroscopically guided core decompression does not allow precise targeting or reliable debridement of the lesion. Tunnel endoscopy helps the surgeon to aim precisely at the lesion and to debride it thoroughly, with accurate visual verification. In conclusion, the arthroscopic-endoscopic assistance may lead to more accurate patient selection, more precise targeting, and more complete debridement, with no apparent disadvantages.

Minimal Invasive Percutaneous Core Decompression For Avascular Necrosis of Femoral Head

Medtronic METRxTM system was originally designed for microdiscectomy which provide access to spine with less trauma. This system is special designed metal tubes (dilators) with progressive increase in size. These dilators when inserted sequentially from small to large size will gradually separate the muscle, so that an opening is created for the surgical instruments to work in. With modified technique, we apply this system to be used in core decompression of femoral head.

Profunda femoris artery pseudoaneurysm after surgery and trauma

Pseudoaneurysms of the profunda femoris artery have been reported following different types of trauma and from orthopedic procedures performed in the proximal femur. Two cases of profunda femoris artery pseudoaneurysm with two rare causes are presented. The first one is a core decompression of femoral head for osteonecrosis and the second one is a proximal femur fracture nailing. Awareness and careful follow-up are the key issues for the early diagnosis.

Avascular necrosis of the femoral head after femoral neck fracture.

Trauma-induced avascular necrosis of the femoral head represents the most common femoral head aseptic necrosis. An alteration in blood supply to the femoral head is the cause of the vascular necrosis. Another mechanism in the genesis of femoral head necrosis is the tamponade effect. Femoral head necrosis may be asymptomatic for a long time, even in patients in whom late segmental collapse already is present. Radiography does not allow diagnostic reliability until 6 months after fracture. The presence of a low signal intensity band away from the fracture line on magnetic resonance images clearly delimits the necrotic area. Once segmental collapse has developed, the diagnosis becomes simple using plain radiographs. The treatment of established femoral necrosis complicating fractures of the upper end of the femur is approached as a therapeutic problem lacking an optimal solution. The main therapeutic options are femoral head-preserving procedures and joint reconstruction. Among the procedures that preserve the femoral head are joint unloading, femoral head core decompression, electric stimulation, osteotomy, and bone grafting. Joint reconstruction procedures including cup arthroplasty, hemiresurfacing, total hip resurfacing, femoral head replacement, femoral head endoprosthesis, and total arthroplasty will be reviewed.