[Comprehensive management of early stage avascular necrosis of femoral head by arthroscopic minimally invasive surgery].

OBJECTIVE

To evaluate the effectiveness of comprehensive management for early stage avascular necrosis of the femoral head (ANFH) by arthroscopic minimally invasive surgery by comparing with closed core decompression.

METHODS

Between January 2007 and March 2010, 28 patients (33 hips) with early stage ANFH were treated with the procedure of arthroscopic core decompression combined with autogenous cancellous bone graft and bone morphogenetic protein (BMP) in 18 cases (21 hips, trial group) or with simple closed core decompression in 10 cases (12 hips, control group). No significant difference was found in gender, age, disease duration, etiology, and staging between 2 groups (P > 0.05).

RESULTS

Incision healed primarily in all patients, and no infection occurred. All patients were followed up 2.5 years on average (range, 1-3 years). Pain relief and improvement of hip function were obtained in all patients at 6 months after operation. At last follow-up, the Harris scores were 85.67 +/- 4.78 in trial group and 81.33 +/- 7.03 in control group, showing significant difference between 2 groups (t = -2.10, P = 0.04). Collapse of the femoral head was observed in 1 hip (Ficat stage II) of trial group, and in 2 hips (Ficat stage I) and 2 hips (Ficat stage II) of control group; hip arthroplasty was performed. Significant difference in total effective rate was found between trial group and control group (95.24% vs. 66.67%; chi2 = 4.85, P = 0.03).

CONCLUSION

Arthroscopic core decompression combined with autogenous cancellous bone graft and BMP is more effective than traditional closed core decompression for treatment of early stage ANFH in pain relief, improvement of hip function, slowing-down the process of femoral head necrosis, reduction of hip joint replacement by accurate location of the lesions, and thoroughly debridement of necrotic bone.