OUTCOMES OF CORE DECOMPRESSION WITH INJECTION OF BONE MARROW ASPIRATE FOR PEDIATRIC FEMORAL HEAD OSTEONECROSIS

摘要

Background: Pediatric patients with femoral head osteonecrosis (FHON) often suffer from significant pain with decreased mobility. Once femoral head collapse occurs, few options are available short of a total hip arthroplasty (THA). ~([1,2]) Core decompression by drilling of the femoral head is used to improve pain and prevent further femoral head collapse, however most of the literature on this technique involves adult patients. ~([3-5]) Purpose: To date, there is no description of this technique or its outcomes in pediatric patients with FHON secondary to other etiologies other than sickle cell disease (SCD). ~([6]) The purpose of our study is to determine outcomes in patients with FHON after undergoing core decompression with injection of bone marrow aspirate (BMA). Methods: A retrospective chart review was performed of all pediatric patients at our institution between 2007-2019 with FHON that underwent core decompression with injection of BMA. The following etiologies were identified: SCD, steroid-induced, Perthes disease (PD), slipped capital femoral epiphysis (SCFE), trauma, idiopathic, or other. To determine if core decompression with injection results in cessation of further femoral head collapse, two outcomes were assessed: Stulberg classification and number of cases that required THA. Furthermore, we evaluated whether core decompression with injection occurred in combination with any additional surgical procedure. Results: Twenty-six hips with FHON were identified with the following etiologies: 12 SCD (46.3%), 8 steroid-induced (30.8%), 2 PD (7.7%), 1 SCFE (3.8%), 1 trauma (3.8%), 1 idiopathic (3.8%), 1 other (3.8%). Mean age at the time of surgery was 12.7 years (range: 8-18). Twenty hips (76.9%) were seen in males and 6 (23.1%) were seen in females. Twenty-two hips (84.6%) were seen in black patients and 4 (15.4%) in white patients. Mean follow-up was 37.9 months (range: 0.6-77.8). Mean Stulberg classification was 3.15 (SD: 1.26). Twelve hips (46.2%) required concomitant femoral and/or pelvic osteotomies while 14 hips (53.8%) underwent core decompression with injection alone. Six hips required conversion to THA after initial core decompression and injection. All hips requiring THA were seen in patients with core decompressions and injections but no additional femoral and/or pelvic osteotomies. Conclusion: Most hips undergoing core decompression with injection did not require THA. Of the hips that required THA, all were seen in patients who only had core decompression and injection of BMA but no concomitant femoral and/or pelvic osteotomies. Figure 1. Intraoperative fluoroscopy during core decompression Figure 2. Stulberg classifications Figure 3. Surgical procedure and rate of conversion to THA