Evaluation of core decompression for early osteonecrosis of the femoral head.
Twenty-six hips (19 patients) with osteonecrosis of the femoral head with stage I or II of the disease, according to the Ficat and Arlet classification, underwent core decompression. Osteonecrosis was confirmed histologically in all 26 hips. Of 19 patients, 7 had prognostic factors traditionally associated with poor outcome including collagen vascular disease and continued use of steroids. The follow-up period averaged 7 years 10 months (range: 2 years 5 months-13 years 8 months) for 17 patients with 24 hips. Two patients died secondary to systemic illness. Seventeen hips (65.4%) had very good or good results using the Ficat criteria. Eight hips (30.8%) needed further operation [total hip arthroplasty (THA) for 7 hips, osteotomy for 1 hip]. Of the 12 hips in patients who had used steroids, 6 hips (50%) were converted to THA. Four hips in patients with systemic lupus erythematosus (SLE) needed THA (100%). We conclude that core decompression provides an effective treatment for steroid-associated osteonecrosis other than in cases with SLE, as well as providing effective treatment for non-steroid-associated osteonecrosis in the early stages of the disease.
Maniwa
S
S
Department of Orthopedics, Shimane Medical University, Izumo, Japan. smaniwa@shimane-med.ac.jp
Nishikori
T
T
Furukawa
S
S
Kajitani
K
K
Iwata
A
A
Nishikawa
U
U
Ochi
M
M
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019299:Decompression, Surgical; D005260:Female; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome