Treatment of Femoral Head Osteonecrosis (Stages 2B, 3 Ficat) Through Open Direct Core Decompression by Allograft Impaction and Light Bulb Technique

Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 1 Department of Orthopedic Surgery, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran 2 Trauma Research Center, Department of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

3 Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran

10.22038/abjs.2020.49380.2452

Abstract

Background: Femoral head avascular necrosis is the cause of paralyzing status of youth population. Initial diagnosis
is the main element in treating the disease. Bone grafting and core decompression are the approved cures at the early
steps of the disease. Hip replacement in a total manner is the common cure in the final stages. The optimal treatment in
the intermediate stages is partially disputable. We investigated several patients with femoral head osteonecrosis cured
with impacted cancellous allograft and open core decompression using the lightbulb technique.
Methods: A total of 46 patients (58 hips) suffering from femoral head osteonecrosis were evaluated in this crosssectional
study. Patients were classified into two groups: A (stage 2B Ficat) and B (stage 3 Ficat) to be treated with the
impaction of cancellous allograft and by open core decompression. Radiographic results, demographic data, and range
of hip joint motions were recorded. The patients were assessed through employing the Harris hip score (HHS) and
visual analogue scale (VAS) index prior to operation and over five years following surgery. We also studied radiographic
alterations of femoral head.
Results: The means of HHS and VAS were developed following the operation. Radiographic outcomes promoted in
both groups, however, it was better in group A. 12 (40%) and six (22%) hips (40%) in groups A and B, respectively
displayed developed stages following the operation. The hip ROM was enhanced with the mean of 15-20 degrees
(p <0.005).
Conclusion: Open core decompression combined with allograft impaction sounds to be influential in the developing
steps of femoral head necrosis and leads to joint discomfort and diminished pain improving ROM of the hip joint and
meanwhile procrastinating the worsening of the disease.
Level of evidence: IV

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