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Related Experiment Videos

Does pain predict outcome in hips with osteonecrosis?

Carlos J Belmar1, Marvin E Steinberg, Karen M Hartman-Sloan

  • 1Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.

Clinical Orthopaedics and Related Research
|August 5, 2004
PubMed
Summary

Nontraumatic osteonecrosis of the hip often progresses without treatment. Early surgical intervention, like core decompression and grafting, improves outcomes regardless of initial pain levels, especially when the femoral head has not yet collapsed.

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Area of Science:

  • Orthopedics
  • Bone disease research

Background:

  • Osteonecrosis of the hip frequently leads to femoral head collapse without intervention.
  • The relationship between preoperative pain and hip osteonecrosis outcomes remains debated.
  • Surgeons may delay treatment for asymptomatic or minimally symptomatic hips, assuming a better prognosis.

Purpose of the Study:

  • To investigate the correlation between preoperative pain, disease stage, necrosis extent, and outcomes in patients with nontraumatic hip osteonecrosis.
  • To evaluate the effectiveness of core decompression and grafting in treating hip osteonecrosis.
  • To determine if preoperative pain influences the prognosis of hip osteonecrosis before femoral head collapse.

Main Methods:

  • Retrospective review of 328 hips in 235 patients with nontraumatic osteonecrosis.

Related Experiment Videos

  • All hips underwent core decompression and bone grafting.
  • Correlation analysis of preoperative stage, necrosis extent, Harris pain scores, and clinical/radiographic outcomes over a mean 46-month follow-up.

    • Main Results:

    • Surgically treated hips demonstrated better outcomes compared to untreated hips.
    • A significant correlation exists between clinical outcome and the stage and size of the necrotic lesion.
    • Femoral head collapse was associated with increased pain and poorer outcomes; however, preoperative pain level did not correlate with outcome before collapse.

    Conclusions:

    • Core decompression and grafting improve outcomes in hip osteonecrosis.
    • The size and stage of the necrotic lesion are critical prognostic factors, more so than preoperative pain.
    • Prophylactic treatment for hip osteonecrosis should not be withheld due to a lack of pain, as asymptomatic hips can still progress to collapse.