Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head

Autor: Tim Claßen, Sebastian Warwas, Stefan Landgraeber, Marcus Jäger
Rok vydání: 2017
Předmět:
Calcium Phosphates
Male
lcsh:Diseases of the musculoskeletal system
Percutaneous
Arthroplasty
Replacement
Hip
Medizin
Avascular necrosis
0302 clinical medicine
Femur Head Necrosis
Orthopedics and Sports Medicine
Prospective Studies
Stage (cooking)
030222 orthopedics
Bone Transplantation
Femur Neck
Impaction
Osteonecrosis
Bone graft substitutes
Middle Aged
Decompression
Surgical
Prosthesis Failure
Treatment Outcome
medicine.anatomical_structure
Technical Advance
Female
Bone Wires
Adult
medicine.medical_specialty
Core decompression
Calcium Sulfate
Transplantation
Autologous
Young Adult
03 medical and health sciences
Femoral head
Rheumatology
medicine
Humans
Tissue engineering
Reamer
Femoral neck
Hip
business.industry
030229 sport sciences
medicine.disease
Surgery
Fluoroscopy
Bone Substitutes
Orthopedic surgery
lcsh:RC925-935
business
Organ Sparing Treatments
Follow-Up Studies
Zdroj: BMC Musculoskeletal Disorders
BMC Musculoskeletal Disorders, Vol 18, Iss 1, Pp 1-8 (2017)
ISSN: 1471-2474
DOI: 10.1186/s12891-017-1811-y
Popis: Background: "Advanced Core Decompression" (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO4)-calcium phosphate (CaPO4) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to present and evaluate a modified technique of ACD with impaction of autologous bone derived from the femoral neck into the necrotic defect. Methods: A cohort of patients with an average follow-up of 30.06 months (minimum 12 months) was evaluated for potential collapse of the femoral head and any reasons that led to replacement of the operated hip. Only patients in stages 2a to 2c according to the Steinberg classification were included in the study. Results: In 75.9% the treatment was successful with no collapse of the femoral head or conversion to a total hip replacement. Analysis of the results of the different subgroups showed that the success rate was 100% for stage 2a lesions and 84.6% respectively 61.5% for stages 2b and 2c lesions. Conclusions: Previous studies with a comparable follow-up reported less favourable results for ACD without autologous bone. Especially in stages 2b and 2c the additional use of autologous bone has a positive effect. In comparison to other hip-preserving techniques, the modified ACD technique is a very promising and minimally invasive method for treatment of ONFH. Trial registration: German clinical trials register (DRKS00011269, retrospectively registered). OA gold
Databáze: OpenAIRE
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