1. Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head.
- Author
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Landgraeber S, Warwas S, Claßen T, and Jäger M
- Subjects
- Adult, Arthroplasty, Replacement, Hip adverse effects, Bone Wires, Calcium Phosphates adverse effects, Calcium Sulfate adverse effects, Decompression, Surgical instrumentation, Female, Femur Head Necrosis pathology, Fluoroscopy instrumentation, Fluoroscopy methods, Follow-Up Studies, Humans, Male, Middle Aged, Organ Sparing Treatments methods, Prospective Studies, Prosthesis Failure, Transplantation, Autologous methods, Treatment Outcome, Young Adult, Bone Substitutes adverse effects, Bone Transplantation methods, Decompression, Surgical methods, Femur Head Necrosis surgery, Femur Neck transplantation
- Abstract
Background: "Advanced Core Decompression" (ACD) is a new technique for treatment of osteonecrosis of the femoral head (ONFH) that includes removal of the necrotic tissue using a percutaneous expandable reamer followed by refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO
4 )-calcium phosphate (CaPO4 ) bone graft substitute. As autologous bone has been shown to be superior to all other types of bone grafts, the aim of the study is to present and evaluate a modified technique of ACD with impaction of autologous bone derived from the femoral neck into the necrotic defect., Methods: A cohort of patients with an average follow-up of 30.06 months (minimum 12 months) was evaluated for potential collapse of the femoral head and any reasons that led to replacement of the operated hip. Only patients in stages 2a to 2c according to the Steinberg classification were included in the study., Results: In 75.9% the treatment was successful with no collapse of the femoral head or conversion to a total hip replacement. Analysis of the results of the different subgroups showed that the success rate was 100% for stage 2a lesions and 84.6% respectively 61.5% for stages 2b and 2c lesions., Conclusions: Previous studies with a comparable follow-up reported less favourable results for ACD without autologous bone. Especially in stages 2b and 2c the additional use of autologous bone has a positive effect. In comparison to other hip-preserving techniques, the modified ACD technique is a very promising and minimally invasive method for treatment of ONFH., Trial Registration: German clinical trials register ( DRKS00011269 , retrospectively registered).- Published
- 2017
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