NOVEL TREATMENT FOR FEMORAL HEAD OSTEONECROSIS USING MICRO-CORE DECOMPRESSION AND INTRALESIONAL ZOLENDRONIC ACID: A PROSPECTIVE STUDY

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 zoledronic 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 zoledronic 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 zoledronic infiltration effectively improves outcomes in early to intermediate AVN, with minimal complications. This novel technique holds promise for hip preservation, particularly in younger patients.

Recommendation

Baseline screening of hip joints at diagnosis and then at regular intervals to screen the patients for any asymptomatic avascular necrosis and early treatment is recommended.

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