title: Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study.
abstract: OBJECTIVE
  The treatment of osteonecrosis of the femoral head (ONFH) remains controversial. A recently proposed treatment is multiple drilling core decompression combined with systemic alendronate as a femoral head-preserving procedure for ONFH. However, it is not known whether alendronate enhances the risk of collapse. We wondered whether the combined procedure could delay or prevent progression of ONFH compared to multiple drilling alone.
  
  
  METHODS
  Patients with early-stage ONFH were randomly assigned to be treated with either multiple drilling combined with alendronate (47 patients, 67 hips) or multiple drilling alone (46 patients, 60 hips). We defined failure as the need for THA or a Harris score less than 70. The minimum follow-up was 48 months for the 77 patients completing the protocol.
  
  
  RESULTS
  After a minimum 4-year follow-up, 91% (40/44) of patients with Stage II disease and 62% (8/13) of patients with Stage III disease had not required THA in alendronate group, compared to 79% (31/39) of patients with Stage II disease and 46% (6/13) of patients with Stage III disease had not required THA in control group (P=0.12, P=0.047, respectively). Small or medium and central lesions had a better successful rate in both groups. Risk factors did not seem to affect the clinical successful rate of this procedure.
  
  
  CONCLUSIONS
  Multiple small-diameter drilling core decompression combined with systemic alendronate administration can reduce pain and delay progression of early-stage ONFH. Even in Ficat IIA and III hips, some benefit was obtained from this approach at least delay in the need for THA.
authors: Orthopaedic Department, West China Hospital, Sichuan University, Chengdu (610041), PR China.
authors: Pengde
authors: P
authors: Kang
authors: Fuxing
authors: F
authors: Pei
authors: Bin
authors: B
authors: Shen
authors: Zongke
authors: Z
authors: Zhou
authors: Jing
authors: J
authors: Yang
mesh_terms: D000328:Adult; D019386:Alendronate / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D018450:Disease Progression; D005260:Female; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate