Treatment of Femoral Head Osteonecrosis (Stages 2B, 3 Ficat) Through Open Direct Core Decompression by Allograft Impaction and Light Bulb Technique

Abstract

Background: Femoral head avascular necrosis is the cause of paralyzing status of youth population. Initial diagnosis<br />is the main element in treating the disease. Bone grafting and core decompression are the approved cures at the early<br />steps of the disease. Hip replacement in a total manner is the common cure in the final stages. The optimal treatment in<br />the intermediate stages is partially disputable. We investigated several patients with femoral head osteonecrosis cured<br />with impacted cancellous allograft and open core decompression using the lightbulb technique.<br />Methods: A total of 46 patients (58 hips) suffering from femoral head osteonecrosis were evaluated in this crosssectional<br />study. Patients were classified into two groups: A (stage 2B Ficat) and B (stage 3 Ficat) to be treated with the<br />impaction of cancellous allograft and by open core decompression. Radiographic results, demographic data, and range<br />of hip joint motions were recorded. The patients were assessed through employing the Harris hip score (HHS) and<br />visual analogue scale (VAS) index prior to operation and over five years following surgery. We also studied radiographic<br />alterations of femoral head.<br />Results: The means of HHS and VAS were developed following the operation. Radiographic outcomes promoted in<br />both groups, however, it was better in group A. 12 (40%) and six (22%) hips (40%) in groups A and B, respectively<br />displayed developed stages following the operation. The hip ROM was enhanced with the mean of 15-20 degrees<br />(p <0.005).<br />Conclusion: Open core decompression combined with allograft impaction sounds to be influential in the developing<br />steps of femoral head necrosis and leads to joint discomfort and diminished pain improving ROM of the hip joint and<br />meanwhile procrastinating the worsening of the disease.<br />Level of evidence: IV