Mid-term outcomes of arthroscopic-assisted Core decompression of Precollapse osteonecrosis of femoral head—minimum of 5?year follow-up

摘要

BackgroundOsteonecrosis of the femoral head (ONFH) is a progressive disease caused by an interruption of blood flow to the femoral head that leads to collapse and the development of secondary arthritis. Mont et al. estimated the prevalence of total hip arthroplasty (THA) involving osteonecrosis to be between 8—12%. With an estimated annual volume of THA of 371,000, it is projected that roughly 37,000 cases of THA involve ONFH [1,2,3]. Epidemiologically, patients in the 30’s to 40’s are commonly affected, resulting in a significant functional impairment in a relatively young population culminating in a loss of productivity for both the individual and society [4]. There are numerous direct and indirect risk factors associated with the development of ONFH. Direct factors include fractures, dislocation, sickle cell disease, and radiation. Indirect factors include corticosteroid use, excessive alcohol intake, certain metabolic syndromes, and smoking [3, 5]. Overall, the most commonly implicated risk factors are corticosteroids, alcohol, and trauma. Finally, it is also common for cases to occur idiopathically with no identified risk factor [6,7,8].The preferred management of ONFH remains controversial and is largely dependent on the staging of the lesion. While there are several classification systems, the Ficat-Arlet staging is commonly used, with stages 0 through IIb considered precollapse, and stages III and IV considered collapsed [3, 9]. (Table?1) Management options can be categorized into observation, non-operative treatment, and operative treatment. Observation may allow small asymptomatic lesions to spontaneously resolve, although most lesions will progress [10]. Lieberman et al. found that 67% of asymptomatic hips and 85% of symptomatic hips managed with observation progress to collapse [11]. Non-operative therapies include bisphosphates, statins, prostaglandins, and hyperbaric oxygen. These treatments have been shown to decrease pain, but long-term outcomes are uncertain and require randomized control trials [10, 12]. Mont et al. literature review proposes that non-operative treatment may be attempted in asymptomatic hips, but once symptoms manifest operative treatment is indicated [7].