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Does lesion size affect the outcome in avascular necrosis?
M E Steinberg1, R E Bands, S Parry
1The Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Clinical Orthopaedics and Related Research
|November 5, 1999
Summary
Avascular necrosis lesion size significantly impacts hip treatment outcomes. Smaller necrotic lesions in the femoral head predict better results after core decompression and bone grafting compared to larger ones.
Area of Science:
- Orthopedics
- Radiology
- Biomedical Engineering
Background:
- Avascular necrosis of the femoral head is a debilitating condition.
- Predicting treatment outcomes for avascular necrosis is challenging.
- Current staging methods often do not fully incorporate lesion size.
Purpose of the Study:
- To investigate the correlation between necrotic lesion size and treatment outcomes in avascular necrosis.
- To evaluate the efficacy of core decompression and bone grafting based on lesion size.
- To determine if lesion size is a critical factor in predicting the need for total hip replacement.
Main Methods:
- Seventy-three hips with avascular necrosis (Stages I and II) underwent core decompression and bone grafting.
- Lesion size was quantified using quantitative magnetic resonance imaging (Stage I) and digital radiography (Stage II).
- Hips were categorized into three groups based on lesion size: <15%, 15-30%, and >30% femoral head involvement.
Main Results:
- No significant outcome differences were observed between Stages I and II, or based on etiology.
- Outcomes correlated significantly with lesion size: smaller lesions (<15%) showed better Harris hip scores and lower rates of total hip replacement (7%) compared to medium (15-30%) and large (>30%) lesions (31% and 33% respectively).
- Radiographic progression was minimal in small lesions but significant in medium and large lesions.
Conclusions:
- Necrotic lesion size is a crucial factor in predicting outcomes for avascular necrosis treated with core decompression and bone grafting.
- Accurate measurement and staging of lesion size are essential for effective management of avascular necrosis.
- These findings may inform treatment decisions for both surgical and non-surgical interventions in avascular necrosis.