title: Results of multiple drilling compared with those of conventional methods of core decompression.
abstract: We performed multiple drilling as a femoral head-preserving procedure for osteonecrosis of the femoral head thinking the therapeutic effects of core decompression could be achieved by this simpler procedure than core decompression. We retrospectively reviewed 136 patients (163 hips) who had multiple drilling using 9/64-inch Steinmann pins for treatment of nontraumatic osteonecrosis of the femoral head. The mean followup for patients who did not require additional surgery (113 hips) was 87 months (range, 60-134 months). We defined failure as the need for additional surgery or a Harris hip score less than 75. After a minimum 5-year followup, 79% (31/39) of patients with Stage I disease and 77% (62/81) of patients with Stage II disease had no additional surgery. All (15/15) small lesions (<25% involvement) and 84% (37/44) of medium-sized lesions (25-50% involvement) were considered successful. Survival rates of patients with Ficat Stages I or II lesions were greater than survival rates for patients with Stage III lesions. Hips with a large necrotic area had poor results. We had one instance of subtrochanteric fracture through drill entry holes. Multiple drilling is straightforward with few complications and produces results comparable to results of other core decompression techniques.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Song
authors.forename: Jeong Joon
authors.initials: JJ
authors.lastname: Yoo
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Hee Joong
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology; D005271:Femur Head Necrosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome