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.


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.”


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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

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