Abstract
Aims: Avascular necrosis of the femoral head (AVN) evolves in destruction of the hip joint. Treatment of this disease is controversial. Early stages are treated with core decompression whilst in later stages þbular grafting, rotational osteotomy or THR are recommended. Purpose of this study is the evaluation of a new combined approach. Methods: We present a series of 147 AVN in 108 patients treated with the combination of core decompression, bone grafting and electrical stimulation. All surgery were performed with a minimal invasive technique and a dedicated set of instruments which allow for accurate and complete removal of the necrotic bone.
In 30 cases the disease was in Steinberg stage I, 58 stage II, 42 stage III and 17 stage IV. All patients were kept non weight bearing for 6 weeks and partial weight bearing for further 6 to 8 weeks. PEMF were used for 8 ours daily for 3 months. Average follow-up was 37 months (min 12 months, max 108). Both clinical and radiological results were evaluated. Results: We had a good radiographic result in 96% of cases in stage I, 85% stage II, 45% stage III and 27% stage IV. Clinically, we obtained good results in 87% stage I, in 81% stage II, in 65% stage III and in 48% stage IV. Clinical failure was deþned as the performance of a subsequent operation. None of the patients in stage I or II required further surgical treatment. Nine cases in stage III and 5 in stage IV required THR after an average of 19 months. Conclusions: Core decompression with bone grafting and electrical stimulation is a safe and effective procedure in Stage I and Stage II AVN. Promising results were obtained also in stage III and Stage IV.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
