Core decompression versus other joint preserving treatments for osteonecrosis of the femoral head: a meta-analysis.
Osteonecrosis of femoral head (ONFH) leads to hip osteoarthritis (HOA); among joint preserving treatments (JPT), the role of core decompression (CD) is still debated. We assessed the efficacy of CD compared with all other JPT in delaying the natural osteonecrosis evolution to HOA.



Following the PRISMA checklist, the Medline and Scopus databases were searched. Fifteen- to 70-year-old subjects with ONFH with a minimum follow-up of 24 months were considered. The outcomes evaluated were patient clinical status, radiographic progression and total hip arthroplasty (THA) or further surgery (FS) need. Risk ratio (RR) was calculated for every outcome reported. RCT, CCT and prospective studies were included.



A total of 12 studies (776 patients) met the inclusion criteria. Clinical outcome (RR = 1.14; 95% CI 0.58-2.32; P = 0.05), radiographic progression (RR = 1.64; 95% CI 1.14-2.35; P = 0.05) and the need for THA/FS (RR = 1.52; 95% CI 0.95-2.45; P = 0.05) suggested a slight superiority of other JPT compared with CD.



High heterogeneity of the primary investigations was the main limitation of our study.



The efficacy and effectiveness of core decompression for ONFH are, at best, no better than other joint preserving strategies. The more recent scientific evidence seems to suggest that such procedure is less successful than other joint preserving strategies.



Further studies are needed to identify the best therapeutic approach to the ONFH.
Department of Public Health, Orthopaedic and Traumatology Unit, 'Federico II' Naples University School of Medicine and Surgery, Naples, Italy.
Francesco
F
Sadile
Department of Public Health, Orthopaedic and Traumatology Unit, 'Federico II' Naples University School of Medicine and Surgery, Naples, Italy.
Alessio
A
Bernasconi
Department of Public Health, Orthopaedic and Traumatology Unit, 'Federico II' Naples University School of Medicine and Surgery, Naples, Italy.
Sergio
S
Russo
Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy Centre for Sports and Exercise Medicine, William Harvey Research Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK n.maffulli@qmul.ac.uk.
Nicola
N
Maffulli
D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D018849:Controlled Clinical Trials as Topic; D019299:Decompression, Surgical; D005260:Female; D005271:Femur Head Necrosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
core decompression; femoral head; hip osteoarthritis; joint preserving treatments; osteonecrosis