The Results of Core Decompression Treatment in Avascular Necrosis of the Femoral Head

Özet

Objective: Avascular necrosis of the femoral head (AVNFH) is a progressive disease seen in young, active patients, leaving significantdisability in the joint when untreated. We retrospectively examined the results of patients with early stage AVNFH who hadbeen operated in our clinic.Methods: In our study, 65 hips of 46 patients were evaluated retrospectively. These patients were evaluated clinically by the Merled'Aubigné–Postel Score and Harris Hip Score. The patients were radiologically staged according to the criteria by Ficat and Arletwith hip anterior-posterior and lateral graphs and magnetic resonance imaging.Results: The mean follow-up period of the patient group was 73 months, and the mean age of the patients was 35 years. Ofthese patients, 59% were female and 41% were male; 41% had bilateral and 40% had right hip involvement. One of the patientsdeveloped AVNFH while she was pregnant, 7 were idiopathic, and 38 (81%) developed AVNFH due to steroid use. According tothe Ficat and Arlet classification, 18 hips were found to be stage 1, 37 hips stage 2, and 9 hips stage 3 during admission. From theetiological point of view, 81% of the patients developed AVNFH while using steroid and 19% had idiopathic AVNFH. As for clinicalimprovement of the patients, the Harris Hip Score increased from 58 to 90 in idiopathic patients and 55 to 83 among steroid users.The Merle d'Aubigné–Postel classification scores increased from 6 to 15 in the idiopathic group and from 6 to 13 among steroidusers. Radiologically, according to the Ficat and Arlet stage, progression was seen in all stages. Of the patients, 38.8% in stage 1,70.2% in stage 2, and 88.8% in stage 3 showed progression, whereas 20% demonstrated rapid progression and needed total hipprosthesis. All patients who demonstrated progression were on chronic steroid therapy. The mean time to conversion to total hipreplacement was 27 months.Conclusion: Osteonecrosis is a disease associated with high morbidity. Early diagnosis can reduce morbidity and improve a patient’squality of life. Core decompression has the effect of stopping the progression of AVNFH in the early (stage 1) stages, althoughit has a significant and long-term palliative effect in all stages. Most of the young and active patients with AVNFH still donot have any ideal method for treatment today, but core decompression in the early stages has been seen to reduce morbidity. Itis a time-saving attempt before the final treatment, which is hip arthroplasty, is performed.