Advanced core decompression, a new treatment option of avascular necrosis of the femoral head – a first follow-up
Corresponding Author
Stefan Landgraeber
Department of Orthopaedics, University of Duisburg-Essen, Germany
Correspondence to: S. Landgraeber, Department of Orthopaedics, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany. E-mail: [email protected]Search for more papers by this authorJens M. Theysohn
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
Search for more papers by this authorTim Classen
Department of Orthopaedics, University of Duisburg-Essen, Germany
Search for more papers by this authorMarcus Jäger
Department of Orthopaedics, University of Duisburg-Essen, Germany
Search for more papers by this authorSebastian Warwas
Department of Orthopaedics, University of Duisburg-Essen, Germany
Search for more papers by this authorHans-Peter Hohn
Institute of Anatomy, University of Duisburg-Essen, Germany
Search for more papers by this authorWojciech Kowalczyk
Chair of Mechanics and Robotics, University of Duisburg-Essen, Germany
Search for more papers by this authorCorresponding Author
Stefan Landgraeber
Department of Orthopaedics, University of Duisburg-Essen, Germany
Correspondence to: S. Landgraeber, Department of Orthopaedics, University of Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany. E-mail: [email protected]Search for more papers by this authorJens M. Theysohn
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
Search for more papers by this authorTim Classen
Department of Orthopaedics, University of Duisburg-Essen, Germany
Search for more papers by this authorMarcus Jäger
Department of Orthopaedics, University of Duisburg-Essen, Germany
Search for more papers by this authorSebastian Warwas
Department of Orthopaedics, University of Duisburg-Essen, Germany
Search for more papers by this authorHans-Peter Hohn
Institute of Anatomy, University of Duisburg-Essen, Germany
Search for more papers by this authorWojciech Kowalczyk
Chair of Mechanics and Robotics, University of Duisburg-Essen, Germany
Search for more papers by this authorAbstract
Aseptic necrosis of the femoral head (AVN) leads to destruction of the affected hip joint, predominantly in younger patients. Advanced core decompression (ACD) is a new technique that may allow better removal of the necrotic tissue by using a new percutaneous expandable reamer. A further modification is the refilling of the drill hole and the defect with an injectable, hard-setting, composite calcium sulphate (CaSO4)–calcium phosphate (CaPO4) bone graft substitute. Compression tests were performed on seven pairs of femoral cadaver bones. One femur of each pair was treated with ACD, while the opposite side remained untreated. Clinically, the postoperative outcome of 27 hips in 23 patients was performed by physical examination 6 weeks after ACD and at average follow-up of 9.69 months, and compared with the preoperative results. MRI was used to assess the removal of the necrotic tissue, any possible progression of AVN and evaluation of collapse. In the biomechanical analysis, the applied maximum compression force that caused the fracture did not significantly differ from the untreated opposite side. The overall results of postoperative physical examinations were significantly better than preoperatively. Five hips (18.5%) were converted to a total hip replacement. The follow-up MRIs of the other patients showed no progression of the necrotic area. The first follow-up results of ACD have been encouraging for the early stages of aseptic necrosis of the femoral head. In our opinion, an assured advantage is the high stability of the femoral neck after ACD, which allows quick rehabilitation. Copyright © 2012 John Wiley & Sons, Ltd.
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