Original Article

Efficacy of Core Decompression of Femoral Head to Treat Avascular Necrosis in Intravenous Drug Users

Abstract

Core decompression (CD) of the femoral head is one of the effective treatments of avascular necrosis (AVN), especially in the early stages of the disease. To investigate further the value of CD in treating the AVN, this study was performed on patients with symptomatic AVN with different etiologies who were treated with CD. This study was carried out on 25 patients (with the total number of 37 femoral head) who were diagnosed AVN using X-Ray and MRI. The CD treatments for these patients were started soon after the diagnosis. The results were considered as a success if there was no progression of disease confirmed by X Ray or no subsequent operation was required. Modified Ficat staging was used to record changes before and 2 years after CD treatment. Twenty five patients were participated in this study in which 68% (n=17) were female, 32% (n=8) were male, and the average of the age of the patients were 29.58±4.58. Eight of these patients had systemic lupus erythematous (SLE) (32%), 4 rheumatoid arthritis (RA) (16%), 3 with kidney transplant (12%), 1 Takayasu's vasculitis (4%) and 1 Wegner vasculitis (4%). Eight of patients had a history of intravenous injection of Temgesic (32%). In patients using Temgesic the changes in Modified Ficat staging were significantly different before and after CD treatment (P=0.03) in comparison with other groups. And in all 8 Temgesic users AVN progressed to the stage 3 and 4 after CD treatment. This study demonstrated that CD treatment to prevent the changes in the femoral head has been more effective in patients with collagen vascular diseases and kidney transplant than patients using intravenous Temgesic. These patients, in spite of early operation, showed no benefit of CD to prevent the changes in the femoral head.

Wang BL, Sun W, Shi ZC, Zhang NF, Yue DB, Guo WS, et al. Treatment of nontraumatic osteonecrosis of thefemoral head with the implantation of core decompression and concentrated autologous bone marrow containing mononuclear cells. Arch Orthop Trauma Surg. [Research Support, Non-U.S. Gov't]. 2010;130(7):859-65.

Smith SW, Fehring TK, Griffin WL, Beaver WB. Core decompression of the osteonecrotic femoral head. J BoneJoint Surg Am. [Review]. 1995 May;77(5):674-80.

Arlet J. Nontraumatic avascular necrosis of the femoral head. Past, present, and future. Clin Orthop Relat Res 1992;(277):12-21.

Bellot F, Havet E, Gabrion A, Meunier W, Mertl P, de Lestang M. [Core decompression of the femoral head for avascular necrosis]. Rev Chir Orthop Reparatrice Appar Mot 2005;91(2):114-23.

Marker DR, Seyler TM, Ulrich SD, Srivastava S, Mont MA. Do modern techniques improve core decompression outcomes for hip osteonecrosis? Clin Orthop Relat Res 2008;466(5):1093-103.

Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br. 1985;67(1):3-9.

Steinberg ME, Brighton CT, Corces A, Hayken GD, Steinberg DR, Strafford B, et al. Osteonecrosis of the femoral head. Results of core decompression and grafting with and without electrical stimulation. Clin Orthop RelatRes. [Clinical Trial Controlled Clinical Trial ResearchSupport, Non-U.S. Gov't]. 1989;(249):199-208.

Cagatay AA, Kucukkaya R, Akyildiz M, Berk H, Cagatay Y, Yildirmak T, et al. Human immunodeficiency virus and avascular necrosis of the femoral head: a case report. Chin Med J (Engl). [Case Reports]. 2004 Sep;117(9):1437-40.

Sighinolfi L, Carradori S, Ghinelli F. Avascular necrosis of the femoral head: a side effect of highly active antiretroviral therapy (HAART) in HIV patients? Infection 2000;28(4):254-5.

Miller KD, Masur H, Jones EC, Joe GO, Rick ME, KellyGG, et al. High prevalence of osteonecrosis of the femoral head in HIV-infected adults. Ann Intern Med 2002;137(1):17-25.

Matos MA, Alencar RW, Matos SS. Avascular necrosis of the femoral head in HIV infected patients. Braz J Infect Dis 2007;11(1):31-4.

Fisher DE, Bickel WH. Corticosteroid-induced avascular necrosis. A clinical study of seventy-seven patients. J Bone Joint Surg Am 1971;53(5):859-73.

Anderton JM, Helm R. Multiple joint osteonecrosis following short-term steroid therapy. Case report. J Bone Joint Surg Am 1982;64(1):139-41.

Mirzai R, Chang C, Greenspan A, Gershwin ME. The pathogenesis of osteonecrosis and the relationships to corticosteroids. J Asthma 1999;36(1):77-95.

Goorney BP, Lacey H, Thurairajasingam S, Brown JD. Avascular necrosis of the hip in a man with HIV infection. Genitourin Med 1990 Dec;66(6):451-2.

Gerster JC, Camus JP, Chave JP, Koeger AC, Rappoport G. Multiple site avascular necrosis in HIV infected patients. J Rheumatol 1991;18(2):300-2.

Rademaker J, Dobro JS, Solomon G. Osteonecrosis and human immunodeficiency virus infection. J Rheumatol 1997;24(3):601-4.

Files
IssueVol 51, No 4 (2013) QRcode
SectionOriginal Article(s)
Keywords
Avascular Necrosis Core Decompression Intravenous drug use
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Abrisham SMJ, Hajiesmaeili MR, Soleimani H, Pahlavanhosseini H. Efficacy of Core Decompression of Femoral Head to Treat Avascular Necrosis in Intravenous Drug Users. Acta Med Iran. 1;51(4):250-253.