Core decompression treatment of early-stage osteonecrosis of femoral head resulted from venous stasis or artery blood supply insufficiency.

BACKGROUND

The objective of this study was to explore the therapeutic effect of core decompression on different hemodynamics changes associated with osteonecrosis of the femoral head (ONFH).

METHODS

A total of 67 patients with 76 hips suffering from ONFH (Arco stage I-IIC) received core decompression surgical procedure. Radiographic, magnetic resonance imaging, and digital subtraction angiography examinations were performed before operation. Radiographic and magnetic resonance imaging follow-ups were also performed after 12, 24, and 60 mo of operation. Clinical follow-ups were performed using the Harris Hip Score (HHS) for an average period of 5 y postoperation.

RESULTS

The mean follow-up time ranged from 2-8 y with an average of 5 y. Two hips were lost during follow-up. Successful clinical efficacy (HHS ≥80) was achieved in 91.9% (68/74) of the hips. Six hips had conversion to total hip arthroplasty (THA), one hip had venous stasis, and five hips had both vein stasis and artery blood supply insufficiency. The mean HHS for the patients who did not have conversion to THA improved from 65 ± 3.5 to 89 ± 3.6 (mean ± standard deviation). Twenty-six stage I hips (100%), 22 of 23 stage IIA hips (95.7%), 13 of 15 stage IIB hips (86.7%), and 8 of 10 stage IIC hips (80%) had successful outcomes with no surgical complications. Kaplan-Meier survival analysis showed that 8-y survival rate was significantly different between stage I and stage IIC (THA as an end point; P < 0.001).

CONCLUSIONS

In patients with early-stage ONFH resulted from only venous stasis, core decompression led to a significant improvement in HHS and 8-y survival rate. However, the long-term efficacy for ONFH associated with artery blood supply insufficiency was not encouraging. Therefore, preoperative digital subtraction angiography is necessary before performing core decompression.