The first experience of arthroscopy in the case of aseptic necrosis of the femoral head

Authors

  • Maxim Golovakha Zaporizhzhia State Medical University. Ukraine, Ukraine https://orcid.org/0000-0003-2835-9333
  • Vadym Kirichenko «Garvis» Clinic, Dnipro. Ukraine, Ukraine
  • Olexandra Grytsenko «Garvis» Clinic, Dnipro. Ukraine, Ukraine
  • Rostyslav Tytarchuk «Garvis» Clinic, Dnipro. Ukraine, Ukraine
  • Stanislav Bondarenko «Motor Sich» Clinic, Zaporizhzhia. Ukraine, Ukraine

DOI:

https://doi.org/10.15674/0030-59872021239-44

Keywords:

Hip joint, aseptic necrosis, arthroscopy

Abstract

Observation of patients with avascular necrosis of the femoral head formed a hypothesis about inability to eliminate the hip contracture by tunneling the femoral head on the background of drug therapy and therapeutic exercises, which causes an unsatisfactory outcomes. Therefore, the was idea to use arthroscopy for performing capsulotomy, synovectomy and removal of free cartilage and bone fragments. Objective. To evaluate efficiency of arthroscopy in patients with avascular necrosis of the femoral head. Methods. In the period from 2010 to 2018, 60 patients were observed. With the I–II stages, absence of inflammatory processes in the joint, body mass index less than 35. In the comparison group (28 patients) we made  only tunneling of the femoral head, in the study group (32) at first  we performed arthroscopy of the hip joint, capsulotomy, synovectomy, removal of cartilage fragments, and only then — tunneling. We analyzed the proportion of hip joint replacement that was performed in the long term follow up and the intensity of pain by visual analog scale. Results. During arthroscopy we often revealed the joint cartilage lesions — 30 %, articular labrum lesions — 5 %, synovitis — 100 %, CAM impingement — 90 %. In the study group in the first 2 weeks after surgery, the pain was severe more than in the comparison group. Then the pain rate became the same in both groups. In the control group in the period from 3 to 5 years after tunneling of the femoral head, arthroplasty was performed in 11 patients (39.3 %), in the study group for 2 to 3 years after surgery — 8 (25.0 %). Conclusions. Analysis of long-term results of tunneling of the femoral head with arthroscopy of the hip joint in patients with avascular necrosis of the femoral head showed improvement in hip function, no disease progression in 60–75 % patients in 2–3 years after surgery.

Author Biographies

Maxim Golovakha, Zaporizhzhia State Medical University. Ukraine

MD, Prof. in Traumatology and Orthopaedics

Vadym Kirichenko, «Garvis» Clinic, Dnipro. Ukraine

MD, PhD in Traumatology and Orthopaedics

Olexandra Grytsenko, «Garvis» Clinic, Dnipro. Ukraine

MD

Rostyslav Tytarchuk, «Garvis» Clinic, Dnipro. Ukraine

MD

Stanislav Bondarenko, «Motor Sich» Clinic, Zaporizhzhia. Ukraine

MD

References

Filipenko, V. A., Olinichenko, G. D., Miteleva, Z. M., & Poletaeva, N. Yu. (2013). The results of surgical treatment of aseptic necrosis of the femoral head in the early stages. Orthopedics, Traumatology and Prosthetics, 1, 5–9. https://doi.org/10.15674/0030-5987201315-9. [in Ukrainian]

Hsu, H., & Nallamothu, S. V. (2020). Hip Osteonecrosis. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499954

Lieberman, J. R., Berry, D. J., Mont, M. A., Aaron, R. K., Callaghan, J. J., Rayadhyaksha, A., & Urbaniak, J. R. (2002). Osteonecrosis of the hip. The Journal of Bone and Joint Surgery-American Volume, 84(5), 834-853. https://doi.org/10.2106/00004623-200205000-00023

Mont, M. A., Marulanda, G. A., Jones, L. C., Saleh, K. J., Gordon, N., Hungerford, D. S., & Steinberg, M. E. (2006). Systematic analysis of classification systems for osteonecrosis of the femoral head. The Journal of Bone and Joint Surgery-American Volume, 88, 16-26. https://doi.org/10.2106/00004623-200611001-00004

Kachanov, D. A., Usov, S. A., & Vostrilov, I. M. (2019). Possibilities of treatment of aseptic necrosis of the femoral head. International research journal, 12(90), 201–203. https://doi.org/10.23670/IRJ.2019.90.12.042. [in Russian]

Martín-Hernández, Bejarano-Lasunción, Martínez-Aznar, Rodríguez-Nogué, Hernández-Fernández, & Pinilla-Gracia. (2020). Epidemiología, resultados clínicos Y tasa de éxito en cirugía preservadora de cadera en la necrosis avascular de Cabeza femoral. Acta Ortopédica Mexicana, 34(1), 16-21. https://doi.org/10.35366/94618

Hanke, M. S., Schmaranzer, F., Steppacher, S. D., Lerch, T. D., & Siebenrock, K. A. (2020). Hip preservation. EFORT Open Reviews, 5(10), 630-640. https://doi.org/10.1302/2058-5241.5.190074

Martinot, P., Dartus, J., Leclerc, J. T., Putman, S., Girard, J., & Migaud, H. (2020). Hip survival after plain core decompression alone versus bone morphogenetic protein and/or bone marrow reinjection with core decompression for avascular osteonecrosis of the femoral head: A retrospective case control study in ninety two patients. International Orthopaedics, 44(11), 2275-2282. https://doi.org/10.1007/s00264-020-04692-w

Martinot, P., Dartus, J., Justo, A., Riouach, H., Cremer, P., Flouzat-Lachaniette, C., ... & Chiron, P. (2020). Does augmented core decompression decrease the rate of collapse and improve survival of femoral head avascular necrosis? case-control study comparing 184 augmented core decompressions to 79 standard core decompressions with a minimum 2 years’ follow-up. Orthopaedics & Traumatology: Surgery & Research, 106(8), 1561-1568. https://doi.org/10.1016/j.otsr.2020.03.040

McCarthy, J., Puri, L., Barsoum, W., Lee, J., Laker, M., & Cooke, P. (2003). Articular cartilage changes in avascular necrosis: An Arthroscopic evaluation. Clinical Orthopaedics and Related Research, 406, 64-70. https://doi.org/10.1097/00003086-200301000-00011

Rocchi, M., Del Piccolo, N., Mazzotta, A., Giavaresi, G., Fini, M., Facchini, F., Stagni, C., & Dallari, D. (2020). Core decompression with bone chips allograft in combination with fibrin platelet-rich plasma and concentrated autologous mesenchymal stromal cells, isolated from bone marrow: Results for the treatment of avascular necrosis of the femoral head after 2 years minimum follow-up. HIP International, 30(2 suppl), 3-12. https://doi.org/10.1177/1120700020964996

Sekiya, J. K., Ruch, D. S., & Hunter, D. M. (2000). Hip arthroscopy in staging avascular necrosis of the femoral head. Journal of the Southern Orthopaedic Association, 9(4), 254–261.

Published

2021-11-26

Issue

Section

ORIGINAL ARTICLES

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