Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis.

Steppacher, Simon D.; Sedlmayer, Raphael; Tannast, Moritz; Schmaranzer, Florian; Siebenrock, Klaus A. (2020). Surgical hip dislocation with femoral osteotomy and bone grafting prevents head collapse in hips with advanced necrosis. Hip international, 30(4), pp. 398-406. Sage 10.1177/1120700019856010

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QUESTIONS

Does surgical hip dislocation with drilling or bone grafting, cartilage treatment and femoral osteotomy in avascular necrosis of the femoral head (AVN) result in: (1) progression of osteonecrosis or osteoarthritis; (2) pain relief and improved function; and (3) subsequent surgery and complications?

METHODS

We retrospectively reviewed 12 patients (13 hips, mean age 29 ± 9 years) undergoing surgical hip dislocation for AVN. Preoperative ARCO stages were: 1 hip ARCO II, 8 hips ARCO III early, 4 hips ARCO III late. Drilling was performed in 4 hips, 9 hips underwent curettage, drilling and autologous bone grafting. Cartilage was sutured in 5 hips, autologous matrix-induced chondrogenesis was performed in 3 hips, an osteochondral autograft was used in 1 hip. Femoral osteotomy was performed in 10 hips. Mean follow-up was 3 ± 2 years. Progression of AVN and osteoarthritis was assessed preoperatively and at latest follow-up using Tönnis and ARCO staging. Pain and function were assessed with the Merle d'Aubigné-Postel score. Complications were graded according to Sink et al.

RESULTS

1 hip had AVN progression and converted to THA. 9 hips showed no AVN- or advanced osteoarthritis progression and 3 hips improved at least 1 ARCO stage. The Merle d'Aubigné-Postel score increased from preoperatively 14.1 ± 3.2 to 16.6 ± 1.2 (p = 0.012). Subsequent surgery were performed in 3 hips, complications occurred in 3 hips.

CONCLUSION

Although the first results are promising a longer follow-up with more patients is needed to draw a definite conclusion regarding the joint preserving potential in AVN.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
UniBE Contributor:	Steppacher, Simon Damian, Sedlmayer, Raphael, Tannast, Moritz, Schmaranzer, Florian, Siebenrock, Klaus-Arno
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1724-6067
Publisher:	Sage
Language:	English
Submitter:	Kathrin Aeschlimann
Date Deposited:	29 Oct 2019 16:46
Last Modified:	05 Dec 2022 15:31
Publisher DOI:	10.1177/1120700019856010
PubMed ID:	31204506
Uncontrolled Keywords:	Avascular necrosis of the femoral head cartilage repair femoral osteotomy hip joint preserving hip surgery surgical hip dislocation
URI:	https://boris.unibe.ch/id/eprint/134155