What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femo
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REVIEW ARTICLE
What are the outcomes of core decompression without augmentation in patients with nontraumatic osteonecrosis of the femoral head? Octavian Andronic 1,2 & Ori Weiss 2,3 & Haitham Shoman 2,4 & Philipp Kriechling 1 & Vikas Khanduja 2 Received: 25 August 2020 / Accepted: 26 August 2020 # The Author(s) 2020
Abstract Purpose Core decompression (CD) of the femoral head is performed to preserve the hip in avascular necrosis (AVN). The outcome following this procedure differs based on the medical centre and the technique. Also, the time to total hip replacement (THR) and the percentage of patients subsequently undergoing a THR are controversial. Methods A systematic review was performed following PRISMA guidelines. The search included CENTRAL, MEDLINE, EMBASE, Scopus, AMED and Web of Science Core Collection databases. Studies reporting the outcome of CD for AVN were assessed. Studies using additional implants, vascularized grafts or any type of augmentation were excluded. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC) tool. Trial registration International prospective register of systematic reviews (PROSPERO) - CRD42018100596. Results A total of 49 studies describing 2540 hips were included. The mean weighted follow-up time was 75.1 months and the mean age at surgery was 39 years. Twenty-four of 37 studies reported improvement in all outcome scores, whilst 9/37 studies report only partial improvement post-operatively. Four studies (4/37) described poor clinical outcomes following intervention. Data was pooled from 20 studies, including 1134 hips with a weighted mean follow-up of 56 months. The percentage of hips undergoing THR averaged 38%. The time to THR had a weighted mean of 26 months after CD. Conclusion Pooled results from 1134 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 38% of patients underwent a total hip replacement at an average of 26 months following core decompression without augmentation. Keywords Core decompression . Hip preservation . Hip arthroscopy . Avascular osteonecrosis of the femoral head . AVN . Osteonecrosis
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00264-020-04790-9) contains supplementary material, which is available to authorized users. * Vikas Khanduja [email protected] 1
Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
2
Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke’s - Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
3
Department of Orthopaedic Surgery, Meir Medical Center, Kfar-Saba, Israel
4
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Osteonecrosis or avascular necrosis (AVN) of the femoral head is a challenging condition that ultimately leads to patients undergoing a total hip replacement (THR) [1]. These patients are young and therefore
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