Avascular Necrosis of Head of Femur – Stage of Arrival in Hospital and Management Options

Vol 4 | Issue 1 | Jan-Jun 2019 | page:35-39  |Rajendra Sakhrekar, K.H.Sancheti, Rajeev Joshi, Parag Sancheti, Ashok K Shyam


Authors: Rajendra Sakhrekar [1], K.H.Sancheti [1], Rajeev Joshi [1], Parag Sancheti [1], Ashok K Shyam [1,2]

[1] Department of Orthopedics, Sancheti Institute of Orthpedics and Rehabilitation

[2] Indian Orthopaedic research Group, Thane, India

Address of Correspondenc
Dr. Ashok Shyam,
Sancheti Institue of Orthopedics and Rehabiliation, Shivajinagar, Pune – 16
Email: drashokshyam@gmail.com.


Abstract

Objective: Both non operative and operative procedures are advised for avascular necrosis of femoral head depending on stage of avascular necrosis of femoral head. There are studies which investigate the functional outcomes of non operative and operative management independently. We aim to do a study in which satisfaction and functional outcomes of both conservative-oral bisphosphonates therapy and operative-total hip replacement studied respectively in a single study.
Materials and Method: A prospective cohort study was conducted between period of June 2015 to December 2016. All avascular necrosis of femoral head patients were screened and 100 patients fulfilling the inclusion exclusion criteria were selected and divided in 2 groups 50 patients in each . Patients were followed for a period of 12 ± 2 months (14 to 19 months). At final follow up patients were evaluated using Harris hip scoring and SF 36 scoring system.
Results: At the mean time of 12 months follow-up, The Harris hip score increased from 45.96 (range, 32 – 65 ) pre-operatively to 89.36 (range, 84 – 96 ) post-operatively and The SF 36 score PCS increased from 30.46 (range, 32 – 52 ) pre-operatively to 39.75 (range, 20 – 50 ) post-operatively and MCS from 37.58 (range, 32 – 52 ) pre-operatively to 50.72 (range, 20 – 50 ) post-operatively for total hip  replacement group. While for conservative group the Harris hip score increased from 67.96 (SD +/-5.41) pre-treatment to 73.98 (SD +/-8.86 ) 1 year follow up. While The SF 36 score PCS increased from 35.00 (SD +/-3.64 ) ) pretreatment to 49.75 (SD +/- 3.71) post-treatment and MCS from 40.56 (SD +/-5.41 ) pre- treatment to 51.11 (SD +/-5.41 ) 1 year post- treatment.
Conclusion: We conclude that bisphosphonates are helpful in postponing surgical intervention and retarding the progression of collapse in of avascular necrosis of the femoral head, more markedly in stage-I and stage-II disease. Hence The natural history of avascular necrosis of the femoral head can be favorably altered by bisphosphonates. For stage III and IV AVN , total hip replacement with ceramic on ceramic bearings has good surgical as well as functional outcomes, as evidenced by significant improvement in Harris hip scores, VAS score and SF-36 score, with significant
improvement in post-operative range of motion and mobility.
Type of study: Prospective case series
K e y w o r d s : “ A V N f e m o r a l h e a d , bisphosphonates, total hip replacement,Harris hip score, SF 36 score.”


References

1.Amber Goraya, Uzma Habib , Aysha Anjum. MRI findings
in spinal tuberculosis. PJHMS,2013: Vol.7 no.4 Oct-Dec, 1166-69.
2. Sajid A, Raj Kumar R, Kanchan D, et al.MRI evaluation of
spinal tuberculosis. Al Ameen J Med Sci, 2013; 6(3):219- 225.
3. Dunn R. The medical management of spinal tuberculosis: SAOJ Autumn 2010;9:37-41
4. Jain AK.Tuberculosis of spine. A fresh look at an old disease. J Bone Joint Surg Br 2010; 92:905-13.
5. Bajwa GR. Evaluation of the role of MRI in spinal
tuberculosis. A study of 60 cases. Pak J Med Sci 2009; 25(6):944-947.
6. Polley P, Dunn R. Nonconatiguous spinal tuberculosis. Incidence and management. Eur Spine J 2009; 18:1096-101.
7. Chauhan A , Gupta B B. Spinal tuberculosis. India Academy of Clinical Medicine, 2007; 8:110-4.
8. Danchaivijitr, jevarans S , thempmongkhol K et al. Diagnostic accuracy of MR imaging in tubercular spondylitis. J Med Asso Thai 2007; 90: 1581-89.
9. Moore MS; Tuberculosis of spine. Contemporary thoughts on current issues and perspective. Curr Orthop 2007; 21:364-79.
10. Tuli SM . Tuberculosis of the spine. A historical review. Clin Orthop Relat Res 2007; 460:29-38.
11. Bone CM .Spectrum of spine infections in patients with Hiv: A case reprt and review of literature. Clin Orthop Relat Res 2006; 444: 83-91.
12. Govinder S. Spinal infections. J Bone Joint Surg Br 2005; 87-B: 1454-58.
13. Na-Young Jung , Won-Hee Jee , Kee Yong Ha et al. Discrimination of tubercular spondylitis from pyogenic spondylitis on MRI. AJR 2004;182: 1405-1410.
14. Muckey T ,Schiltz T ,Kirschner M , Psoas abcess: the spine a primary source of infection 2003;28 (6): E 106-13.
15. Alothman A, Memish ZA, Awada A, et al.Tuberculosis of spine: Analysis of 69 cases from Saudi Arabia.Spine,2001; 26:565-70.
16. Bareau NT, Cardinal E. Imaging of musculosketal and
spinal infections in AIDS. Radiol Clin North Am 2001; 39:343-355.
17. Moor SL , Rafi M. Imaging of musculosketal and spinal tuberculosis. Radiol Clin North Am 2001; 39:329-342.
18. Catran SR, Kumar V, Tuclin C. Robbins Patologic basis of disease. 6th ed. Philadelphia: Sanders, 1999: 349-352.
19. Vidyasagar C, Murthy H K. Spinal tuberculosis with neurological deficit. Natl Med J India1996 ; 9(1): 25-27.
20. Shanley D J.tuberculosis of spine. Imaging features. AJR 1995; 164: 659-64.
21. Sherif H S , Morgan J L, Shaheed M S et al. Role of CT and MRI imaging in management of tubercular spondylitis. Radiol Clin North Am 1995; 33: 787-804.
23. Desai SS.Early diagnosis of spinal tuberculosis by MRI.J bone Joint Surg Br1994:76:865-9.
24. Jallah R D, Kuppusamy I, Mahayddin AA. Spinal tuberculosis: a five years review of cases at a national tuberculosis centre. Med J Malaya 1991; 46(3): 269-73.
25. smith AS, Weinstein MA, Mizushine A et al. MR imaging charecteristics of tubercular spondylitis vs vertebral osteomyelitis. A JNR1989; 10:619-625.
26. Tulsi SM. Treatment of neurological complications of tuberculosis of spine. J bone Joint Surg 1969; 51-A: 680-92.


How to Cite this Article: Sakhrekar R, Sancheti K H, Joshi R, Sancheti P, Shyam A K.
Avascular Necrosis of Head of Femur – Stage of Arrival in Hospital and Management Options. Journal of Orthopaedic and Rehabilitation 2019 Jan-June; 4(1):35-39

 (Abstract)      (Full Text HTML)      (Download PDF)


.