Colaço Henry B, Davidson Jerome A, Davenport Dominic, Norris Mark C, Bankes Marcus J K, Shah Zameer
1 Trauma and Orthopaedics Department, Royal Free Hospital, London - UK.
2 Royal National Orthopaedic Hospital, Stanmore - UK.
Hip Int. 2018 Jan;28(1):90-95. doi: 10.5301/hipint.5000535.
The management of osteonecrosis (ON) of the femoral head remains controversial. It is unclear the extent to which non-arthroplasty procedures are used and there has been no previous report of the trends in operative management of ON in the UK. Our objective is to report current trends in management of ON of the femoral head amongst specialist hip surgeons in the UK.
A single-stage internet-based survey was e-mailed to 352 eligible members of the British Hip Society (BHS). This consisted of 10 question stems including 16 hypothetical clinical scenarios with imaging.
115 active Consultant members of the BHS completed the survey. For symptomatic pre-collapse ON we found core decompression (CD) was the most common operative intervention and for post-collapse ON we found that total hip arthroplasty (THA) was the most common operative intervention. We found no difference in the rate of operative intervention between 24 and 48-year-old patients at any stage of ON but joint preserving procedures were more often selected for the younger patient and arthroplasty for the older patient. Surgeons were more likely to offer arthroplasty to a 48-year-old patient at an earlier stage of disease.
Our respondents would offer different operative interventions dependent on stage of ON and patient age. Core decompression (CD) and arthroplasty were common but variation in treatment options offered suggests a lack of consensus amongst UK hip surgeons. We suggest that further research such as a prospective RCT is needed to gain consensus on management of this condition.
股骨头坏死（ON）的治疗仍存在争议。目前尚不清楚非关节置换手术的使用程度，且此前英国尚无关于ON手术治疗趋势的报告。我们的目的是报告英国髋关节专科外科医生中股骨头坏死治疗的当前趋势。
通过电子邮件向英国髋关节协会（BHS）的352名符合条件的成员进行了单阶段基于互联网的调查。该调查由10个问题主干组成，包括16个带有影像学的假设临床病例。
115名BHS在职顾问成员完成了调查。对于有症状的塌陷前期ON，我们发现髓芯减压（CD）是最常见的手术干预措施；对于塌陷后ON，我们发现全髋关节置换术（THA）是最常见的手术干预措施。我们发现，在ON的任何阶段，24至48岁患者的手术干预率没有差异，但对于年轻患者，更常选择保留关节的手术，而对于老年患者，则选择关节置换术。外科医生更倾向于在疾病早期为48岁患者提供关节置换术。
我们的受访者会根据ON的阶段和患者年龄提供不同的手术干预措施。髓芯减压（CD）和关节置换术很常见，但所提供的治疗选择存在差异，这表明英国髋关节外科医生之间缺乏共识。我们建议需要进行进一步的研究，如前瞻性随机对照试验，以就这种疾病的治疗达成共识。
