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KMID : 0386720020140010024
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Journal of the Korean Hip Society
2002 Volume.14 No. 1 p.24 ~ p.31
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The Joint Preserving Treatment in Osteonecrosis of the Femoral Head
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Hwang Deuk-Soo
Lee Kwang-Jin
Lee HH
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Abstract
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Purpose : Various results have been reported regarding the different treatment methods for early avascular necrosis of the femoral head. The purpose of this study was to search for effective methods by performing a retrograde study on patients who had undergone various forms of joint preserving operation for avascular necrosis of the femur head.
Materials and Methods : Among the patients who were diagnosed with early avascular necrosis of the femoral head during the period between July, 1992, and August, 2000, 113 cases in 83 patients for whom follow up was possible were selected for the study. The joint preserving methods consisted of observation in 14 cases, core decompression in 76, multiple drilling in 14, Sugioka osteotomy in 3, open window and bone graft in 2, and in addition to these cases, ancillary treatment using arthroscopy in 14 cases. Harris hip score evaluation was used as the clinical scale.
Results : Regardless of the severity of femoral head necrosis(ARCO stage), 37 cases(48.68%) of core decompression and 10(71.43%) of multiple drilling showed success in joint preserving(p=0.097). Of the 14 cases with arthroscopy-assisted treatment, 10 received core decompression, and 4 of these needed artificial joint replacement due to further disease progression. Overall, 59 cases(54.13%) were successful in preserving the joint, while50 cases(45.87%) failed. In the cases where joint preserving was successful at the final follow up, the average Harris hip score was 70.30 points.
Conclusion : Multiple drilling showed better results than core decompression, but this is thought to be due to its indication for early disease stage, where the lesion is small. Furthermore, the use of arthroscopy for determination of treatment method according to the severity of avascular necrosis, or as an adjunctive role in the treatment, seems encouraging, and further studies are warranted.
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KEYWORD
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Avascular necrosis of the femur head, core decompression, multiple drilling, Arthroscopy
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