Precollapse femoral head avascular necrosis after combined surgical-medical management

TL;DR

This study shows that combining surgery and medication early can significantly improve hip function in patients with a condition caused by reduced blood flow to the femoral head.

Contribution

The novel contribution is demonstrating the effectiveness of early combined surgical and medical treatment for precollapse avascular necrosis of the femoral head.

Findings

Combined surgical and medical treatment improved hip function in 87.5% of unilateral and 90% of bilateral cases.

No hips remained in the poor outcome category after treatment.

Most cases were idiopathic and at an early stage.

Abstract

Avascular necrosis of the femoral head occurs due to loss of blood supply leading to osteocyte death and progression to collapse if not
treated early. Hence, we followed 60 patients (80 hips) with precollapse AVN (Modified Ficat-Arlet stage I and IIA) who underwent core
decompression with autologous cancellous iliac crest grafting plus a fixed pharmacotherapy protocol for 48 weeks. Harris Hip Score improved
serially, with unilateral hips reaching 87.5% and bilateral hips 90% good to excellent outcomes at final follow up and no hip remaining in
poor category. Most hips were Stage I and idiopathic was the common etiology and the results support that combined surgical plus medical
management gives meaningful short-term functional benefit when started early.