Die konservative Therapie der aseptischen Femurkopfnekrose

[Digital subtraction angiography assisted musculoskeletal flap transplantation for the treatment of osteonecrosis of the femoral head]

OBJECTIVE

To observe the effectiveness of digital subtraction angiography (DSA) assisted musculoskeletal flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).

METHODS

The clinical data of 15 patients with 15 hips of ONFH admitted between January 2016 and December 2019 were retrospectively analyzed. All patients were male, aged 20-45 years, with an average age of 31.6 years. There were hormone type in 9 cases and alcohol type in 6 cases. The disease duration ranged from 15 days to 3 years, with an average of 8 months. The Association Research Circulation Osseous (ARCO) staging: 4 hips in stage Ⅱ, 11 hips in stage Ⅲ. The preoperative visual analogue scale (VAS) score was 6.2±0.2, and the Harris score of the hip joint was 57.3±1.3. Preoperative DSA examination of the femoral head was performed to determine the location of vascular lesions of the femoral head. According to the results of the angiography, the surgical selection of the musculoskeletal flap was guided. For the patients with both superior and inferior retinaculum vessels developed, simple core decompression was performed. For the patients with superior retinaculum vessels developed but inferior retinaculum vessels not developed, anterolateral tensor fasciae flap was used. For the patients whose superior retinaculum did not develop and the inferior retinaculum developed, posterolateral quadratus femoris flap was used. The fibular flap with anastomotic vessels was used in the patients whose superior and inferior retinaculum vessels were not developed.

RESULTS

All 15 cases of 15 hips were followed up 6-24 months, with an average of 14 months. During the follow-up, the patient's ONFH did not worsen, the femoral head did not collapse, the joint space was normal, and the hip joint fextion and extension function was acceptable. At last follow-up, the VAS score was 1.9±0.2, and the hip Harris score was 92.1±0.8, both of which were significantly improved when compared with preoperative ones ( t=14.85, P=0.00; t=23.22, P=0.00).

CONCLUSION

For patients with ONFH who need musculoskeletal flap transplantation, preoperative DSA of femoral head can determine the location of vascular lesions of femoral head, so as to guide the selection of musculoskeletal flap transplantation, which is of great significance for hip-conserving surgery.

Atraumatic Femoral Head Necrosis in Adults

BACKGROUND

Atraumatic necrosis of the femoral head is a common cause of hip arthrosis in middle age. In Germany, it affects 5000-7000 patients per year, corresponding to an incidence of 0.01%. Though rarer than primary hip arthrosis, it is still of major clinical and socio-economic significance. Patients with this problem should be diagnosed early and given stage-appropriate treatment.

METHODS

This review is based on pertinent publications that were retrieved by a selective search in the PubMed, Embase, Medline, and Cochrane Library databases using the terms "osteonecrosis," "femoral head necrosis," "diagnosis," "classification," "conservative treatment," "surgical treatment," "joint preservation," "osteotomy," and "arthroplasty," as well as a recent guideline on atraumatic necrosis of the femoral head in adults.

RESULTS

The etiology and pathogenesis of atraumatic femoral head necrosis in adults are not yet fully clear. The main risk factor is prolonged corticosteroid treatment. Nonspecific complaints and an initially normal plain x-ray of the hip can delay the diagnosis. The diagnosis is established by plain x-ray, computerized tomography, magnetic resonance tomography, and scintigraphy. Conservative treatment alone is not considered adequate. The range of surgical treatments includes joint-preserving and (for more severe necrosis) joint-resecting methods.

CONCLUSION

Atraumatic femoral head necrosis in adults is a disease that progresses in stages; depending on its stage, it can either be cured or lead to hip arthrosis. A full cure is possible only in early stages. Current research focuses on the effect of new drugs on the intermediateand long-term outcome.

A muCT analysis of the femoral bone stock in osteonecrosis of the femoral head compared to osteoarthrosis

INTRODUCTION

Long-term results of resurfacing in osteonecrosis of the femoral head (ONFH) are lacking and migration of the femoral component, necrosis of the femoral head and fracture of the femoral neck or head have been depicted. The aim of this study was to analyse the bone quality and 3-dimensional microarchitecture of the femoral head and neck in patients with ONFH compared to a group of patients with primary osteoarthritis (OA).

MATERIALS AND METHODS

muCT was used to compare the microarchitecture of the femoral head and neck in patients with ONFH (n = 10) and a control group of patients with primary OA (n = 10).

RESULTS

No statistical significant differences were found for bone volume and the bone volume fraction, the connectivity density and the structure model index in patients with ONFH and those with OA (P > 0.05). Patients with ONFH and those with OA had a similar trabecular number, thickness and separation (P > 0.05).

CONCLUSION

Based on our findings, we might conclude that hip resurfacing arthroplasty is a possible therapeutic option in the treatment of ONFH of the young and active patient and that an insufficient bone stock in ONFH seems not to be the deciding factor for failure. However, we just focussed on one of probably various factors. Further studies are needed to support these findings.