Joint Preservation Trends in the Treatment of Osteonecrosis of the Femoral Head

Abstract

Osteonecrosis of the femoral head (ONFH) is problematic because multiple treatment options such as hip joint preservation procedures have been suggested, yet the best treatment for various stages of the disease remains controversial. The purpose of this study was to characterize the trends for hip joint preservation surgical procedures performed for ONFH in the United States between 2008 and 2014 to (1) assess the frequency and rates of surgical procedures for the treatment of femoral head osteonecrosis; (2) determine the frequency and rate of joint preservation procedures; and (3) determine the frequency and rate of hemiarthroplasty/femoral head resurfacing of this cohort. Using the American College of Surgeons National Surgical Quality Improvement Program, all patients who had a diagnosis of ONFH and underwent hip joint preservation surgery or hemiarthroplasty/femoral head resurfacing between the years 2008 and 2014 were identified. The hip joint preservation surgical procedures included bone grafting, core decompression, osteotomy, and arthroscopy. The annual frequency and rate of the various surgical procedures were collected. From 2008 to 2014, the annual number of all surgical procedures for ONFH increased from 88 to 1,161. While the number of core decompression procedures increased, the frequency of other joint preserving procedures stayed relatively the same. As a percentage of all surgical procedures, the percentage of all hip joint preservation procedures decreased from 17 to 3.3% (p < 0.001). This corresponded to decreases in the percentage of bone grafting from 2.2 to 0.4%, core decompression from 12.5 to 2.8%, hip arthroscopy from 1.1 to 0.1%, and osteotomy from 1.1 to 0%. Over the same time period, the percentage of hemiarthroplasty/femoral head resurfacing decreased from 2.3 to 1.3%. The frequency and rate of surgical procedures for ONFH have increased over the years. However, the percentage of hip joint preservation procedures and hemiarthroplasty/femoral head resurfacing has decreased and makes up a smaller percentage of the total surgeries performed for treating ONFH.

Keywords

femoral head collapse - hip joint preservation - osteonecrosis

• References

• 1 Petrigliano FA, Lieberman JR. Osteonecrosis of the hip: novel approaches to evaluation and treatment. Clin Orthop Relat Res 2007; 465 (465): 53-62
• 2 Hungerford DS, Jones LC. Asymptomatic osteonecrosis: should it be treated?. Clin Orthop Relat Res 2004; ;(429): 124-130
• 3 Zalavras CG, Lieberman JR. Osteonecrosis of the femoral head: evaluation and treatment. J Am Acad Orthop Surg 2014; 22 (7) 455-464
• 4 Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 1995; 77 (3) 459-474
• 5 Lieberman JR, Berry DJ, Mont MA , et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect 2003; 52: 337-355
• 6 Min B-W, Song K-S, Cho C-H, Lee S-M, Lee K-J. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res 2008; 466 (5) 1087-1092
• 7 Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. J Bone Joint Surg Am 2010; 92 (12) 2165-2170
• 8 McGrory BJ, York SC, Iorio R , et al. Current practices of AAHKS members in the treatment of adult osteonecrosis of the femoral head. J Bone Joint Surg Am 2007; 89 (6) 1194-1204
• 9 Yin H, Yuan Z, Wang D. Multiple drilling combined with simvastatin versus multiple drilling alone for the treatment of avascular osteonecrosis of the femoral head: 3-year follow-up study. BMC Musculoskelet Disord 2016; 17 (1) 344
• 10 Fang T, Zhang EW, Sailes FC, McGuire RA, Lineaweaver WC, Zhang F. Vascularized fibular grafts in patients with avascular necrosis of femoral head: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2013; 133 (1) 1-10
• 11 Zeng Y-R, He S, Feng W-J , et al. Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head. Int Orthop 2013; 37 (3) 391-398
• 12 Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop 2015; 6 (8) 590-601
• 13 Issa K, Pivec R, Kapadia BH, Banerjee S, Mont MA. Osteonecrosis of the femoral head: the total hip replacement solution. Bone Joint J 2013; 95-B (11, Suppl A) 46-50
• 14 Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985; 67 (1) 3-9
• 15 Lieberman JR, Engstrom SM, Meneghini RM, SooHoo NF. Which factors influence preservation of the osteonecrotic femoral head?. Clin Orthop Relat Res 2012; 470 (2) 525-534
• 16 Mont MA, Jones LC, Sotereanos DG, Amstutz HC, Hungerford DS. Understanding and treating osteonecrosis of the femoral head. Instr Course Lect 2000; 49: 169-185
• 17 Issa K, Johnson AJ, Naziri Q, Khanuja HS, Delanois RE, Mont MA. Hip osteonecrosis: does prior hip surgery alter outcomes compared to an initial primary total hip arthroplasty?. J Arthroplasty 2014; 29 (1) 162-166
• 18 Miller KD, Masur H, Jones EC , et al. High prevalence of osteonecrosis of the femoral head in HIV-infected adults. Ann Intern Med 2002; 137 (1) 17-25
• 19 Nakasone S, Takao M, Sakai T, Nishii T, Sugano N. Does the extent of osteonecrosis affect the survival of hip resurfacing?. Clin Orthop Relat Res 2013; 471 (6) 1926-1934
• 20 Johnson AJ, Mont MA, Tsao AK, Jones LC. Treatment of femoral head osteonecrosis in the United States: 16-year analysis of the Nationwide Inpatient Sample. Clin Orthop Relat Res 2014; 472 (2) 617-623
• 21 NSQIP. American College of Surgeons National Surgical Quality Improvement Program. n.d. https://www.facs.org/quality-programs/acs-nsqip? . Accessed August 11, 2016
• 22 Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 2009; 250 (3) 363-376
• 23 Khuri SF, Daley J, Henderson W , et al; National VA Surgical Quality Improvement Program. The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. Ann Surg 1998; 228 (4) 491-507
• 24 Shiloach M, Frencher Jr SK, Steeger JE , et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010; 210 (1) 6-16
• 25 Drager J, Hart A, Khalil JA, Zukor DJ, Bergeron SG, Antoniou J. Shorter hospital stay and lower 30-day readmission after unicondylar knee arthroplasty compared to total knee arthroplasty. J Arthroplasty 2016; 31 (2) 356-361