title: Elevated intraosseous pressure in the intertrochanteric region is associated with poorer results in osteonecrosis of the femoral head treated by multiple drilling.
abstract: Multiple drilling is reported to be an effective treatment for osteonecrosis of the head of femur, but its effect on intra-osseous pressure has not been described. We undertook multiple drilling and recorded the intra-osseous pressure in 75 osteonecrotic hips in 60 patients with a mean age of 42 years (19 to 67). At a mean follow-up of 37.1 months (24 to 60), 42 hips (56%) had a clinically successful outcome. The procedure was effective in reducing the mean intra-osseous pressure from 57 mmHg (SD 22) to 16 mmHg (SD 9). Hips with a successful outcome had a mean pressure of 26 mmHg (SD 19). It was less effective in preventing progression of osteonecrosis in hips with considerable involvement and in those with a high intra-osseous pressure in the intertrochanteric region (mean 45 mmHg (SD 25)). This study is not able to answer whether a return of the intra-osseous pressure to normal levels is required for satisfactory healing.
authors.affiliation: Department of Orthopaedics, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan 333, Taoyuan, Taiwan. bone@doctor.com
authors.forename: M S
authors.initials: MS
authors.lastname: Lee
authors.forename: P-H
authors.initials: PH
authors.lastname: Hsieh
authors.forename: Y-H
authors.initials: YH
authors.lastname: Chang
authors.forename: Y-S
authors.initials: YS
authors.lastname: Chan
authors.forename: S
authors.initials: S
authors.lastname: Agrawal
authors.forename: S W N
authors.initials: SW
authors.lastname: Ueng
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005270:Femur Head / Q000502:physiology / Q000601:surgery*; D005271:Femur Head Necrosis / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011312:Pressure; D016896:Treatment Outcome