Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head-minimum of 5 year follow-up.
Adolescent
Adult
Arthroplasty, Replacement, Hip
/ statistics & numerical data
Arthroscopy
/ adverse effects
Decompression, Surgical
/ adverse effects
Female
Femur Head
/ diagnostic imaging
Femur Head Necrosis
/ diagnosis
Follow-Up Studies
Humans
Male
Middle Aged
Organ Sparing Treatments
/ adverse effects
Radiography
Reoperation
/ statistics & numerical data
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Young Adult
Core decompression
Femoral head preservation
Femoral head preserving
Hip arthroscopy
Mechanical symptoms
Mid-term follow-up
Mid-term outcomes
ONFH
Osteonecrosis
Osteonecrosis of the femoral head
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
15 Oct 2019
15 Oct 2019
Historique:
received:
11
02
2019
accepted:
25
09
2019
entrez:
17
10
2019
pubmed:
17
10
2019
medline:
25
2
2020
Statut:
epublish
Résumé
Osteonecrosis of the femoral head (ONFH) is a progressive disease that leads to collapse and the development of secondary arthritis. The preferred management of ONFH remains controversial. Arthroscopic-assisted management of ONFH is a new and evolving approach for hip preservation. We hypothesis that arthroscopy is able to improve ONFH outcomes by achieving accurate and minimally invasive decompression while successfully addressing concomitant intraarticular pathologies resulting in reliable mid-term outcomes. This was a retrospective cohort analysis. All patients had atraumatic ONFH with a precollapse lesion and a minimum follow-up of 5 years. A total cohort of 11 hips (8 patients) was identified. The mean patient follow-up was 7 years ±1.48 years (range, 64-118 months). The Ficat-Alret classification found on preoperative imaging was Stage I-3 (27.2%), IIa-4 (36.4%), and IIb-4 (36.4%) hips. Four (36.4%) hips experienced mechanical issues, including locking, catching, and buckling. The most common concomitant pathology addressed at the time of arthroscopy, was labral repair/debridement-8 (73%), followed by microfracture-7 (64%). At final follow-up, 6 hips (54.5%) had not converted to THA. Upon further stratification, Stage I-100%, Stage IIa-75%, for a combined 87%, had not converted to THA, in contrast, 100% of hips categorized as Stage IIb had converted to THA. Ficat-Alret staging, especially Stage IIb, was significantly associated with conversion to THA. (p-value = 0.015) There were 0% major or minor complications. To our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA. Level IV, Case Series.
Sections du résumé
BACKGROUND
BACKGROUND
Osteonecrosis of the femoral head (ONFH) is a progressive disease that leads to collapse and the development of secondary arthritis. The preferred management of ONFH remains controversial. Arthroscopic-assisted management of ONFH is a new and evolving approach for hip preservation. We hypothesis that arthroscopy is able to improve ONFH outcomes by achieving accurate and minimally invasive decompression while successfully addressing concomitant intraarticular pathologies resulting in reliable mid-term outcomes.
METHODS
METHODS
This was a retrospective cohort analysis. All patients had atraumatic ONFH with a precollapse lesion and a minimum follow-up of 5 years.
RESULTS
RESULTS
A total cohort of 11 hips (8 patients) was identified. The mean patient follow-up was 7 years ±1.48 years (range, 64-118 months). The Ficat-Alret classification found on preoperative imaging was Stage I-3 (27.2%), IIa-4 (36.4%), and IIb-4 (36.4%) hips. Four (36.4%) hips experienced mechanical issues, including locking, catching, and buckling. The most common concomitant pathology addressed at the time of arthroscopy, was labral repair/debridement-8 (73%), followed by microfracture-7 (64%). At final follow-up, 6 hips (54.5%) had not converted to THA. Upon further stratification, Stage I-100%, Stage IIa-75%, for a combined 87%, had not converted to THA, in contrast, 100% of hips categorized as Stage IIb had converted to THA. Ficat-Alret staging, especially Stage IIb, was significantly associated with conversion to THA. (p-value = 0.015) There were 0% major or minor complications.
CONCLUSIONS
CONCLUSIONS
To our knowledge, this is the longest reported follow-up of arthroscopic-assisted management of ONFH. Arthroscopic-assisted management is a promising surgical approach that provides safe, accurate, and minimally invasive decompression, resulting in reliable results with an acceptable conversion rate to THA.
LEVEL OF EVIDENCE
METHODS
Level IV, Case Series.
Identifiants
pubmed: 31615502
doi: 10.1186/s12891-019-2853-0
pii: 10.1186/s12891-019-2853-0
pmc: PMC6794765
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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