Novel Treatment for Femoral Head Osteonecrosis Using Micro-Core Decompression and Intralesional Zolendronic Acid

Kumar  Rahul; Nilesh Kumar  Agrawal; Mohsin  Parvez; Wasim  Ahmed; Indrajeet  Kumar; Santosh  Kumar

doi:10.51168/sjhrafrica.v5i12.1471

Authors

Kumar Rahul Senior Resident, Department of Orthopaedics, IGIMS, Patna, Bihar, India
Nilesh Kumar Agrawal Senior Resident, Department of Orthopaedics, IGIMS, Patna, Bihar, India
Mohsin Parvez Senior Resident, Department of Orthopaedics, IGIMS, Patna, Bihar, India
Wasim Ahmed Additional Professor, Department of Orthopaedics, IGIMS, Patna, Bihar, India
Indrajeet Kumar Associate Professor, Department of Orthopaedics, IGIMS, Patna, Bihar, India
Santosh Kumar Professor, Department of Orthopaedics, IGIMS, Patna, Bihar, India

DOI:

https://doi.org/10.51168/sjhrafrica.v5i12.1471

Keywords:

Avascular Necrosis, Micro-Core Decompression, Zolendronic acid, Harris Hip Score, Hip Preservation

Abstract

Background: Avascular necrosis (AVN) of the hip often leads to joint collapse and necessitates total hip arthroplasty, especially in younger patients. Hip preservation strategies, such as core decompression, aim to delay disease progression. Combining micro-core decompression with local zolendronic infiltration is a novel approach with potential advantages.

Methods: This prospective study included 15 patients (19 hips) with AVN stages I to III, treated with micro-core decompression and local zolendronic acid infiltration. Patients were followed for two years, with outcomes assessed using Harris Hip Scores (HHS) and radiological evaluations. Data were analyzed using appropriate statistical tests.

Results: At two years, mean HHS improved significantly across all stages: 97.3 (stage I), 91.1 (stage IIa), 88.4 (stage IIb), and 82.5 (stage III). Radiological improvements included restoration of femoral head morphology and prevention of collapse progression. Postoperative complications were minimal, with two cases of superficial infection and two of trochanteric bursitis, all managed successfully.

Conclusion: Micro-core decompression combined with local zolendronic infiltration effectively improves outcomes in early to intermediate AVN, with minimal complications. This novel technique holds promise for hip preservation, particularly in younger patients.

References

Baig SA, Baig MN. Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management. Cureus. 2018;10(8):3171.

Kakaria HL, Sharma AK, Sebastian B. Total Hip Replacement in Avascular Necrosis of Femoral Head. Med J Armed Forces India. 2005;61(1):33‐5.

Vardhan H, Tripathy SK, Sen RK, Aggarwal S, Goyal T. Epidemiological Profile of Femoral Head Osteonecrosis in the North Indian Population. Indian J Orthop. 2018;52(2):140‐6.

Boskey AL, Raggio CL, Bullough PG, Kinnett JG. Changes in the bone tissue lipids in persons with steroid and alcohol-induced osteonecrosis. Clin Orthop Relat Res. 1983;172:289-95.

Matsuo K, Hirohata T, Sugioka Y, Ikeda M, Fukuda A. Influence of alcohol intake, cigarette smoking, and occupational status on idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res. 1988;234:115- 23.

Koo KH, Kim R, Kim YS, Ahn IO, Cho SH, Song HR, et al. Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment. Clin Rheumatol. 2002;21:299-303.

Angeler MJ, Gianakos A, Villa J, Ni A, Lane J. Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015;6:590-601.

Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect. 2003;52:337-55.

Sen RK. Management of avascular necrosis of femoral head at pre-collapse stage. Indian J Orthop. 2009;43:6-16.

Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am. 1995;77:459-74.

Dayan AY, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Seminars Arthritis Rheumatism. 2002;32(2):94-124.

Ashraf, M., George, J., & Sha, I. I. (2021). Micro-Core decompression combined with intralesional zoledronic acid as a treatment of osteonecrosis of femoral head: A novel technique. Journal of Orthopedics Traumatology and Rehabilitation, 13(1), 21–25. https://doi.org/10.4103/jotr.jotr_46_20

Polkowski GG, Callaghan JJ, Mont MA, Clohisy JC. Total Hip Arthroplasty in the Very Young Patient. J Am Academy Orthopaedic Surg. 2012;20(8):487-97.

Arlet J, Ficat RP. Forage-biopsie de la tete femorale dans 1’osteonecrose primitive; Observations histopathologiques portant sur huit foranes. Rev Rhum Ed Fr. 1964;31:257-64.

Kim SY, Kim DH, Park IH. Multiple drilling compared with core decompression for the treatment of osteonecrosis of the femoral head. J Bone Joint Surg Br. 2004;86:149.

Song WS, Yoo JJ, Kim YM, Kim HJ. Results of Multiple Drilling Compared with Those of Conventional Methods of Core Decompression. Clin Orthopaedics Related Res. 2007;454:139-46.

Li J, Li ZL, Zhang H, Su XZ, Wang KT, Yang YM. Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head. Chinese Med J. 2017;130(12):1435-40.

Peled E, Bejar J, Barak M, Orion E, Norman D. Core decompression and alendronate treatment of the osteo-necrotic rat femoral head: computer-assisted analysis. Int J Exp Pathol. 2013;94:212-6.

Zhang C, Zeng B, Xu Z, Song W, Shao L, Jing D, et al. Treatment of femoral head necrosis with free vascularized fibula grafting: a preliminary report. Microsurgery. 2005;25:305-9.

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;133:1-10.

Agarwala S, Jain D, Joshi VR, Sule A. Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip: a prospective open-label study. Rheumatology. 2005;44:352-9.

Agarwala S, Shah SB. Ten-year follow-up of avascular necrosis of femoral head treated with alendronate for 3 years. J Arthroplasty. 2011;26:1128-34.

Nishii T, Sugano N, Miki H, Hashimoto J, Yoshikawa H. Does alendronate prevent collapse in osteonecrosis of the femoral head. Clin Orthop Relat Res. 2006;443:273-9.

Chen CH, Chang JK, Lai KA, Hou SM, Chang CH, Wang GJ. Alendronate in the prevention of collapse of the femoral head in nontraumatic osteonecrosis: A two-year multicenter, prospective, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 2012;64:1572-8.

Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am. 2005;87:2155-9.

Wei, Biao, Ge, Xiang. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int J Clin Experimental Res Hip Pathology Therapy. 2011;21:206-10.