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Avascular necrosis of the femoral head: three-dimensional measurement of drilling precision reveals high accuracy and no difference between fluoroscopically controlled core decompression and cancellous bone grafting

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Avascular osteonecrosis of the femoral head (AVN) is a widespread disease affecting mostly young and active people, often exacerbating in progressive stages, ending in joint replacement. The most common joint preserving operative therapy for early stages is core decompression (CD), optional with cancellous bone grafting (CBG). For success it is vital that the necrotic area is hit and the sclerotic rim is broken by drilling into the defect zone to relieve intraosseous pressure. The aim of this study was to investigate if both techniques are precise enough to hit the center of the necrosis and if there is a difference in precision between drilling with small pins (CD) and the trephine (CBG).

Patients and methods

10 patients underwent CD, 12 patients CBG with conventional C-arm imaging. Postoperatively 3D MRI reconstructions of the necrotic area and the drilling channels were compared. The deviation of the drilling channel from the center of the necrotic area was measured. PROMs (HHS, HOOS, EQ-5D, SF-36) were evaluated to compare the clinical success of these procedures.

Results

Neither with CD nor with CBG the defect zone was missed. The drilling precision of both procedures did not differ significantly: distance to center 3.58 mm for CD (range 0.0–14.06, SD 4.2) versus 3.91 mm for CBG (range 0.0–15.27, SD 4.7). PROMs showed no significant difference.

Conclusion

Concerning the most important difference between the two procedures—the surgical higher demanding technique of CBG—we suggest applying the less invasive technique of CD alone.

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Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members.

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Authors and Affiliations

  1. Department of Orthopedics, Hospital of Bamberg, Buger Straße 80, 96049, Bamberg, Germany

    Michael Woerner

  2. Department of Orthopedics, University Hospital of Regensburg, Asklepios Klinikum Bad Abbach, KaiserKarl-V.-Allee 3, 93077, Bad Abbach, Germany

    Korbinian Voelkl & Joachim Grifka

  3. Klinikum Lichtenfels, Professor-Arneth-Straße 2B, 96215, Lichtenfels, Germany

    Felix Ferner

  4. Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Markus Weber

  5. Department of Orthopedics and Trauma Surgery, University Hospital of Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany

    Tobias Renkawitz

  6. Universitätsklinikum Marburg, Baldingerstraße, 35043, Marburg, Germany

    Benjamin Craiovan

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  1. Michael Woerner
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Correspondence to Michael Woerner.

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The Authors declare that there is no conflict of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethical approval

This study was conducted after authorisation by the Institutional Ethical Board of the Medical University of Regensburg (No. 14-101-0108). It has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki and has been carried out in accordance with regulations of the US Health Insurance Portability and Accountability Act (HIPAA). Written informed consent for participation in this investigation was obtained from all patients.

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Written informed consent for participation in this investigation was obtained from all patients.

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The work was performed at University Hospital Regensburg, Department for Orthopaedic Surgery, Bad Abbach, Germany.

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Woerner, M., Voelkl, K., Ferner, F. et al. Avascular necrosis of the femoral head: three-dimensional measurement of drilling precision reveals high accuracy and no difference between fluoroscopically controlled core decompression and cancellous bone grafting. Arch Orthop Trauma Surg 143, 4713–4719 (2023). https://doi.org/10.1007/s00402-022-04753-2

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