Treatment of femoral head osteonecrosis with core decompression and subsequent hyperbaric oxygen therapy

Amaç. Femur başı vasküler nekrozu etyolojik sebep ne olursa olsun femur başı lokal kan akımınınazalması ile başlayan bir süreçtir. Çalışmamızın amacı kor dekompresyon sonrası hiperbarikoksijen terapisi ile tedavi edilen evre 1 ve 2 femur başı avasküler nekrozu olgularının klinik veradyolojik sonuçlarını değerlendirmekti. Yöntem. Çalışmamızda kor dekompresyon sonrasıhiperbarik oksijen tedavisi uyguladığımız 16 hastanın 21 kalçasını klinik ve radyolojik olarakretrospektif değerlendirdik. Bulgu. Kısa dönem sonuçlarımızda 1 hasta hariç tüm hastaların VASve Harris kalça skorlarında düzelme tespit ettik. Sonuç. Gerek kor dekompresyon gereksehiperbarik oksijen tedavisi etki mekanizmaları ve sonuçlarına baktığımızda sinerjistik etkigöstererek birbirini tamamlayan tedavi yöntemleridir.

Femur başı osteonekrozunun kor dekomp resyon ve takibinde hiberbarik oksijen uygulaması ile tedavisi

Aim. Regardless the etiologic factor, femoral head avascular necrosis is a process that occurs withfemoral head local blood supply deficiency. The purpose of our study was to evaluate the clinicaland radiologic outcomes in patients diagnozed with grade 1 and 2 avascular necrosis of thefemoral head who were treated with a combination of core decompression and hyperbaric oxygentherapy. Method. In our study we have evaluated 21 hips of 16 patients retrospectively, which wehave treated with a combination of core decompression and hyperbaric oxygen therapy. Weperformed clinical and radiological evaluation to the patients. Result. VAS and Harris hip scoresshowed improvement in all of our patients except in short term results. Conclusion. Coredecompression and subsequent hyperbaric oxygen therapy are accomplishing each other becauseof their synergistic effects.

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1. Strauss M, Dvorak T. Femoral head necrosis and hyperbaric oxygen therapy. In: Kindwall EP, Whelan HT, eds. Hyperbaric medicine practice. Best Publishing Co 1999; 912.
2. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985; 67: 3-9.
3. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg Am 2006; 88: 1117-32.
4. Steinberg ME, Hayken GD, Steinberg DR. A quantitative system for staging avascular necrosis. J Bone Joint Surg Br 1995; 77: 34-41.
5. Belal MA, Reichelt A. Clinical results of rotational osteotomy for treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg 1996; 115: 80- 4.
6. Hasegawa Y, Iwata H, Torii S, Iwase T, Kawamoto K, Iwasada S. Vascularized pedicle bone-grafting for nontraumatic avascular necrosis of the femoral head. A 5- to 11-year follow-up. Arch Orthop Trauma Surg 1997; 116: 251-8.
7. Iorio R, Healy WL, Abramowitz AJ, Pfeifer BA. Clinical outcome and survivorship analysis of core decompression for early osteonecrosis of the femoral head. J Arthroplasty 1998; 13: 34-41
8. Tetik C, Başar H, Bezer M, Erol B, Ağir I, Esemenli T. Comparison of early results of vascularized and non-vascularized fibular grafting in the treatment of osteonecrosis of the femoral head. Acta Orthop Traumatol Turc 2011; 45: 326- 34.
9. Mont MA, Carbone JJ, Fairbank AC. Core decompression versus nonoperative management for osteonecrosis of the hip. Clin Orthop 1996; 324: 169-78.
10. Scully SP, Aaron RK, Urbaniak JR. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am 1998; 80: 1270-5.
11. Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip. A prospective open-label study. Rheumatology 2005; 44: 352-9.
12. Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 2005; 87: 2155-9.
13. Ludwig J, Lauber S, Lauber HJ, Dreisilker U, Raedel R, Hotzinger H. High- energy shock wave treatment of femoral head necrosis in adults. Clin Orthop 2001; 387: 119-26
14. Wang CJ, Wang FS, Huang CC, Yang KD, Weng LH, Huang HY. Treatment for osteonecrosis of the femoral head: comparison of extracorporeal shock waves with core decompression and bone-grafting. J Bone Joint Surg Am 2005; 87: 2380-7.
15. Levin D, Norman D, Zinman C, Rubinstein L, Sabo E, Misselevich I, Reis D, Boss JH. Treatment of experimental avascular necrosis of the femoral head with hyperbaric oxygen in rats: histological evaluation of the femoral heads during the early phase of the reparative process. Exp Mol Pathol 1999; 67: 99-108.
16. Reis ND, Schwartz O, Militianu D, Ramon Y, Levin D, Norman D, Melamed Y, Shupak A, Goldsher D, Zinman C. Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head. J Bone Joint Surg Br 2003; 85: 371-5.
17. Nylander G, Lewis D, Nordström H, Larsson J. Reduction of postischemic edema with hyperbaric oxygen. Plast Reconstr Surg 1985; 76: 596-603.
18. Wang GJ, Dughman SS, Reger SI, Stamp WG. The effect of core decompression on femoral head blood flow in steroid-induced avascular necrosis of the femoral head. J Bone Joint Surg Am 1985; 67: 121-4.
19. Chan TW, Dalinka MK, Steinberg ME, Kressel HY. MRI appearance of femoral head osteonecrosis following core decompression and bone grafting. Skeletal Radiol 1991; 20: 103-7.
20. Ficat RP, ArletJ. Ischemia and Necrosis of Bone. Baltimore, Wİlliams & Wİlkins, 1980.
21. Ito H, Matsuno T, Kaneda K. Prognosis of early stage avascular necrosis of the femoral head. Clin Orthop 1999; 358: 149-57.
22. Merle D'Aubigné R, Postel M, Mazabraud A, Massias P, Gueguen J, France P. Idiopathic necrosis of the femoral head in adults. J Bone Joint Surg Br 1965; 47- B: 612-33.
23. Behnke AR, Saltzman HA. Hyperbaric oxygenation. N Engl J Med 1967; 276: 1423-9.
24. Rajagopal M, Balch Samora J, Ellis TJ. Efficacy of core decompression as treatment for osteonecrosis of the hip: a systematic review. Hip Int 2012; 22: 489-93.
25. Wei BF, Ge XH. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int 2011; 21: 206-10.
26. Karatoprak O, Korkmaz MF, Kara AN, Göğüş A, Işiklar ZU. Early results of autologous mononuclear bone marrow cell implantation in nontraumatic avascular necrosis of the femoral head. Acta Orthop Traumatol Turc 2008; 42: 178-83.
27. Mont MA, Marulanda GA, Seyler TM, Plate JF, Delanois RE. Core decompression and nonvascularized bone grafting for the treatment of early stage osteonecrosis of the femoral head. Instr Course Lect 2007; 56: 213-20.
28. Hunt TK, Pai MP. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 1972; 135: 561-7.
29. Ficat P, Grijalvo P. Long-term results of the forage-biopsy in grade I and II osteonecrosis of the femoral head. Apropos of 133 cases re-examined after an average time of 9 years 6 months. Rev Chir Orthop Reparatrice Appar Mot 1984; 70: 253-5.