Treatment of Femoral Head Osteonecrosis (Stages 2B, 3 Ficat) Through Open Direct Core Decompression by Allograft Impaction and Light Bulb Technique

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 1 Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran 2 Trauma Research Center, Department of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: Femoral head avascular necrosis is the cause of paralyzing status of youth population. Initial diagnosis
is the main element in treating the disease. Bone grafting and core decompression are the approved cures at the early
steps of the disease. Hip replacement in a total manner is the common cure in the final stages. The optimal treatment in
the intermediate stages is partially disputable. We investigated several patients with femoral head osteonecrosis cured
with impacted cancellous allograft and open core decompression using the lightbulb technique.
Methods: A total of 46 patients (58 hips) suffering from femoral head osteonecrosis were evaluated in this crosssectional
study. Patients were classified into two groups: A (stage 2B Ficat) and B (stage 3 Ficat) to be treated with the
impaction of cancellous allograft and by open core decompression. Radiographic results, demographic data, and range
of hip joint motions were recorded. The patients were assessed through employing the Harris hip score (HHS) and
visual analogue scale (VAS) index prior to operation and over five years following surgery. We also studied radiographic
alterations of femoral head.
Results: The means of HHS and VAS were developed following the operation. Radiographic outcomes promoted in
both groups, however, it was better in group A. 12 (40%) and six (22%) hips (40%) in groups A and B, respectively
displayed developed stages following the operation. The hip ROM was enhanced with the mean of 15-20 degrees
(p <0.005).
Conclusion: Open core decompression combined with allograft impaction sounds to be influential in the developing
steps of femoral head necrosis and leads to joint discomfort and diminished pain improving ROM of the hip joint and
meanwhile procrastinating the worsening of the disease.
Level of evidence: IV

Keywords

References

1. Bradway JK, Morrey BF. The natural history of the
silent hip in bilateral atraumatic osteonecrosis. The
Journal of arthroplasty. 1993;8(4):383-7.
2. Glimcher MJ, Kenzora JE. The biology of osteonecrosis
of the human femoral head and its clinical implications:
III. Discussion of the etiology and genesis of the
pathological sequelae; comments on treatment. Clin
Orthop Relat Res. 1979(140):273-312.
3. Urbaniak JR. Avascular necrosis of the femoral head:
etiology, pathophysiology, classification, and current
treatment guidelines. American journal of orthopedics
(Belle Mead, NJ). 2004;33(7):327-32.
4. Herndon JH, Aufranc OE. Avascular necrosis of the
femoral head in the adult: a review of its incidence
in a variety of conditions. Clinical Orthopaedics and
Related Research®. 1972;86:43-62.
5. Glimcher MJ, Kenzora JE. The biology of osteonecrosis
of the human femoral head and its clinical implications:
II. The pathological changes in the femoral head as
an organ and in the hip joint. Clin Orthop Relat Res.
1979(139):283-312.
6. Lieberman JR, Engstrom SM, Meneghini RM, SooHoo
NF. Which factors influence preservation of the
osteonecrotic femoral head?. Clinical Orthopaedics
and Related Research. 2012;470(2):525-34.
7. Mertelsmann-Voss C, Lyman S, Pan TJ, Goodman
S, Figgie MP, Mandl LA. Arthroplasty rates are
increased among US patients with systemic
lupus erythematosus: 1991–2005. The Journal of
rheumatology. 2014;41(5):867-74.
8. Mont MA, Hungerford DS. Non-traumatic avascular
necrosis of the femoral head. JBJS. 1995;77(3):459-74.
9. Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA.
Treatment of osteonecrosis of the femoral head
with free vascularized fibular grafting. A long-term
follow-up study of one hundred and three hips. The
Journal of bone and joint surgery. American volume.
1995;77(5):681-94.
10. Kozinn SC, Wilson JP. Adult hip disease and total hip
replacement. InClinical symposia (Summit, NJ: 1957)
1987 (Vol. 39, No. 5, pp. 1-32).
11. Tsai SW, Wu PK, Chen CF, Chiang CC, Huang CK, Chen
TH, et al. Etiologies and outcome of osteonecrosis of 
the femoral head: etiology and outcome study in a
Taiwan population. Journal of the Chinese Medical
Association. 2016;79(1):39-45.
12. Sorich MM, Cherian JJ, McElroy MJ, Banerjee S,
Jones LC, Minniti CP, et al. Osteonecrosis of the hip
in hematologic disease: A review of conditions and
treatment options. J Long Term Eff Med Implants.
2015;25(4):253-268.
13. Atilla B, Bakırcıoğlu S, Shope AJ, Parvızı J. Jointpreserving
procedures for osteonecrosis of
the femoral head. EFORT Open Reviews. 2019;
4(12):647-58.
14. Veillette CJ, Mehdian H, Schemitsch EH, McKee MD.
Survivorship analysis and radiographic outcome
following tantalum rod insertion for osteonecrosis of
the femoral head. JBJS. 2006;88(suppl_3):48-55.
15. Sun W, Li Z, Gao F, Shi Z, Zhang Q, Guo W. Recombinant
human bone morphogenetic protein-2 in debridement
and impacted bone graft for the treatment of femoral
head osteonecrosis. PLoS One. 2014;9(6).
16. Solomon L. Clinical and therapeutic concepts in
ischemic femur head necrosis. Der Orthopade.
1990;19(4):200-7.
17. Rosenwasser MP, Garino JP, Kiernan HA, Michelsen
CB. Long term followup of thorough debridement
and cancellous bone grafting of the femoral head for
avascular necrosis. Clinical orthopaedics and related
research. 1994 (306):17-27.
18. Maniwa S, Nishikori T, Furukawa S, Kajitani K, Iwata A,
Nishikawa U, et al. Evaluation of core decompression
for early osteonecrosis of the femoral head. Archives
of orthopaedic and trauma surgery. 2000;120(5-
6):241-4.
19. Schneider W, Breitenseher M, Engel A, Knahr K, Plenk
JH, Hofmann S. The value of core decompression
in treatment of femur head necrosis. Orthopade.
2000;29(5):420-9.
20. Ali SA, Christy JM, Griesser MJ, Awan H, Pan X,
Ellis TJ. Treatment of avascular necrosis of the
femoral head utilising free vascularised fibular
graft: a systematic review. Hip International. 2014;
24(1):5-13.
21. Fukui K, Kaneuji A, Matsumoto T. Arthroscopic 
correction for concomitant cam impingement in a
patient with idiopathic osteonecrosis of the femoral
head: A case report. International journal of surgery
case reports. 2016;19:154-8.
22. Yildiz C, Erdem Y, Koca K. Lightbulb technique for the
treatment of osteonecrosis of the femoral head. HIP
International. 2018;28(3):272-7.
The Archives of Bone and Joint Surgery
Volume 8, Issue 5
September 2020
Pages 613-619

Files

History

  • Receive Date: 11 June 2020
  • Accept Date: 12 June 2020

Share

How to cite

Statistics