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Core Decompression with Non Vascularized Fibular Graft as Modern Surgical Treatment of Early Hip Avascular Necrosis
1Dr Mohammad Tariqul Alam, Assistant Professor, Paediatric Orthopaedics, Mymensingh Medical College (MMC), Mymensingh, Bangladesh;
Insights
Avascular necrosis (AVN) of the femoral head can be effectively treated with core decompression and fibular grafting, achieving a 90% success rate. Early intervention and patient mobility are key factors for optimal outcomes in AVN treatment.
Area of Science:
- Orthopedic Surgery
- Bone Diseases
- Regenerative Medicine
Background:
- Avascular necrosis (AVN) involves bone death due to impaired blood supply, commonly affecting the femoral head.
- AVN leads to pain, joint dysfunction, and potential bone collapse, significantly impacting patient quality of life.
Purpose of the Study:
- To evaluate the efficacy of core decompression combined with non-vascularized fibular grafting for treating avascular necrosis of the femoral head.
- To assess the factors influencing treatment outcomes in AVN patients.
Main Methods:
- A quasi-experimental study involving 20 patients (28 hips) with femoral head AVN treated between January 2017 and December 2018.
- Patients underwent core decompression and non-vascularized fibular grafting.
- Outcomes were assessed using the Harris hip score and range of motion, with exclusion of Ficat and Arlet grades III and IV hips.
Main Results:
- The combined procedure demonstrated an average success rate of 90%.
- Patients presenting with a Harris hip score below 60 showed poorer outcomes.
- Limited hip flexion (less than 80 degrees) was also associated with less favorable results.
Conclusions:
- Core decompression with non-vascularized fibular grafting is a highly successful treatment for avascular necrosis of the femoral head.
- Pre-treatment hip function, indicated by Harris hip score and range of motion, predicts treatment success.
Abstract:
Cellular death of bone due to impairment of the blood supply leading to collapse resulting in pain, and loss of joint function is known as avascular necrosis (AVN). The head of femur is the most common bone affected by avascular necrosis followed by talus and scaphoid. We evaluate the results of core decompression with non-vascularized fibular graft in avascular necrosis of femoral head. This quasi experimental study was done at Mymensingh Medical College Hospital, Dhaka Medical College Hospital and some other private hospitals of Bangladesh. The study includes patients who underwent core decompression and non-vascularized fibular grafting in avascular necrosis of femoral head from January 2017 to December 2018. In this study we evaluated total 20 patients and majority of the patients belongs to the group of 20-30 years. Out of 20 patients, 8 of them were unilaterally involved rest 12 had bilateral involvement. Out of 24 hips of bilateral involvement 4 were grade III and IV (Ficat and Arlet classification) therefore not included in the study. So, we study 28 hips only. The average success rate was 90% after core decompression and non-vascularized fibular bone grafting. Harris hip score of 60 on presentation had poorer outcome. Patients with less than 80 degrees of flexion had poorer outcome.
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