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Review
. 2020 Jan 28;4(12):647-658.
doi: 10.1302/2058-5241.4.180073. eCollection 2019 Dec.

Joint-preserving procedures for osteonecrosis of the femoral head

Bülent Atilla  1 , Sancar Bakırcıoğlu  1 , Alexander J Shope  2 , Javad Parvızı  2
Affiliations
Review

Joint-preserving procedures for osteonecrosis of the femoral head

Bülent Atilla et al. EFORT Open Rev. .

Abstract

Osteonecrosis of the femoral head is a poorly understood condition that may lead to progressive destruction of the hip joint. Its incidence is common between the third and fifth decades of life and it is the diagnosis behind 5-18% of annually performed total hip arthroplasties (THAs) in the USA.Regarding the high rate of complications of THA in that age group, authors have agreed on the importance of joint-preservation techniques for this disease but techniques vary to establish a generally accepted algorithmic approach.Surgical head-preserving procedures, core decompression with or without graft, stem cell augmentation, or biologic adjuncts, vascularized bone grafting, and proximal femoral osteotomies have all been published on with heterogeneous results and with limited evidence to date.Consensus states that the prognosis of patients with osteonecrosis of the femoral head can be significantly improved with early diagnosis and timely intervention. Cite this article: EFORT Open Rev 2019;4:647-658. DOI: 10.1302/2058-5241.4.180073.

Keywords: avascular necrosis; core decompression; femoral head; hip; osteonecrosis; total hip arthroplasty.

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Conflict of interest statement

ICMJE Conflict of interest statement: JP reports consultancy to Zimmer Biomet, Stryker, TissueGene, Corentec, Ethicon, Tenor, KCI, Heraeus and 3M; royalties from Corentec, Parvizi Surgical Innovations, Hip Innovation Technology, Alphaeon, Joint Purification Systems, Ceribell, PRN, PRNVeterinary, MD-Valuate, Intellijoint, MicroGenDx and Corentec, all outside the submitted work. The other authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
(a & b) Preoperative X-ray and MRI presentation of Ficat-Arlet Stage II osteonecrosis on both hips of a 21-year-old man. (c & d) He was treated with classic core decompression, curettage and allograft + DBM augmentation. (e) X-ray demonstrates survival of both hips at 11 years follow-up with a remarkable functional outcome. Notes. MRI, magnetic resonance imaging; DBM, demineralized bone matrix.
Fig. 2
Fig. 2
(a) Trapdoor technique, allows for direct visualization of the necrotic lesion, curettage and grafting. (b) Re-suturing the cartilage flap back to its origin.
Fig. 3
Fig. 3
(a) Light bulb technique is performed by hinging a cortical window on the femoral neck at the chondral junction and curettage of the necrotic lesion to the subchondral bone. (b) An external light source applied form the femoral neck illuminates the femoral head trough the surgical tunnel before bone graft impaction.
Fig. 4
Fig. 4
(a) A 27-year-old man presenting with right-hip Stage III osteonecrosis with subchondral fracture. Treatment with a metal hemicap articular surface replacement. (b) At 10 year follow-up, the patient still has good joint function and is working as an emergency care physician.
See this image and copyright information in PMC

References

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