Avascular necrosis of the femoral head: three-dimensional measurement of drilling precision reveals high accuracy and no difference between fluoroscopically controlled core decompression and cancellous bone grafting.

Autor: Woerner M; Department of Orthopedics, Hospital of Bamberg, Buger Straße 80, 96049, Bamberg, Germany. mw2905@web.de., Voelkl K; Department of Orthopedics, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, KaiserKarl-V.-Allee 3, 93077, Bad Abbach, Germany., Ferner F; Klinikum Lichtenfels, Professor-Arneth-Straße 2B, 96215, Lichtenfels, Germany., Weber M; Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany., Renkawitz T; Department of Orthopedics and Trauma Surgery, University Hospital of Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany., Grifka J; Department of Orthopedics, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, KaiserKarl-V.-Allee 3, 93077, Bad Abbach, Germany., Craiovan B; Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Germany.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2023 Aug; Vol. 143 (8), pp. 4713-4719. Date of Electronic Publication: 2023 Jan 19.
DOI: 10.1007/s00402-022-04753-2
Abstrakt: Introduction: Avascular osteonecrosis of the femoral head (AVN) is a widespread disease affecting mostly young and active people, often exacerbating in progressive stages, ending in joint replacement. The most common joint preserving operative therapy for early stages is core decompression (CD), optional with cancellous bone grafting (CBG). For success it is vital that the necrotic area is hit and the sclerotic rim is broken by drilling into the defect zone to relieve intraosseous pressure. The aim of this study was to investigate if both techniques are precise enough to hit the center of the necrosis and if there is a difference in precision between drilling with small pins (CD) and the trephine (CBG).
Patients and Methods: 10 patients underwent CD, 12 patients CBG with conventional C-arm imaging. Postoperatively 3D MRI reconstructions of the necrotic area and the drilling channels were compared. The deviation of the drilling channel from the center of the necrotic area was measured. PROMs (HHS, HOOS, EQ-5D, SF-36) were evaluated to compare the clinical success of these procedures.
Results: Neither with CD nor with CBG the defect zone was missed. The drilling precision of both procedures did not differ significantly: distance to center 3.58 mm for CD (range 0.0-14.06, SD 4.2) versus 3.91 mm for CBG (range 0.0-15.27, SD 4.7). PROMs showed no significant difference.
Conclusion: Concerning the most important difference between the two procedures-the surgical higher demanding technique of CBG-we suggest applying the less invasive technique of CD alone.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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