Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis
| Autor: | Francesco Sadile, Alessio Bernasconi, S. Russo, Nicola Maffulli |
|---|---|
| Přispěvatelé: | Sadile, Francesco, Bernasconi, Alessio, Russo, Sergio, Maffulli, Nicola |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Core decompression Arthroplasty Replacement Hip Radiography MEDLINE Joint preserving treatments hip osteoarthriti law.invention 03 medical and health sciences Femoral head 0302 clinical medicine Randomized controlled trial Femur Head Necrosis law Humans Medicine Hip osteoarthritis Prospective Studies Prospective cohort study Aged Randomized Controlled Trials as Topic joint preserving treatment 030222 orthopedics Invited Review business.industry Medicine (all) Osteonecrosis General Medicine Middle Aged Decompression Surgical Checklist Surgery Treatment Outcome medicine.anatomical_structure 030220 oncology & carcinogenesis Meta-analysis Relative risk Female Controlled Clinical Trials as Topic business |
| Zdroj: | British Medical Bulletin. 118:33-49 |
| ISSN: | 1471-8391 0007-1420 |
| Popis: | Introduction Osteonecrosis of femoral head (ONFH) leads to hip osteoarthritis (HOA); among joint preserving treatments (JPT), the role of core decompression (CD) is still debated. We assessed the efficacy of CD compared with all other JPT in delaying the natural osteonecrosis evolution to HOA. Sources of data Following the PRISMA checklist, the Medline and Scopus databases were searched. Fifteen- to 70-year-old subjects with ONFH with a minimum follow-up of 24 months were considered. The outcomes evaluated were patient clinical status, radiographic progression and total hip arthroplasty (THA) or further surgery (FS) need. Risk ratio (RR) was calculated for every outcome reported. RCT, CCT and prospective studies were included. Areas of agreement A total of 12 studies (776 patients) met the inclusion criteria. Clinical outcome (RR = 1.14; 95% CI 0.58-2.32; P = 0.05), radiographic progression (RR = 1.64; 95% CI 1.14-2.35; P = 0.05) and the need for THA/FS (RR = 1.52; 95% CI 0.95-2.45; P = 0.05) suggested a slight superiority of other JPT compared with CD. Areas of controversy High heterogeneity of the primary investigations was the main limitation of our study. Growing points The efficacy and effectiveness of core decompression for ONFH are, at best, no better than other joint preserving strategies. The more recent scientific evidence seems to suggest that such procedure is less successful than other joint preserving strategies. Areas timely for developing research Further studies are needed to identify the best therapeutic approach to the ONFH. |
| Databáze: | OpenAIRE |
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