gms | German Medical Science

Objectives: The aim after examined the epidemiological and clinical features, comparing cases requiring secondary hip replacement and those who had a favorable outcome. We search for prognostic factors for core decompression.

Methods: The prospective serie included 90 hips. Mean age at decompression was 35.3 years (17–60). In 19 hips, osteonecrosis was favored by corticosteroid treatment, in 13 by chronic alcoholism, and in one by radiotherapy. No favoring factors were present for 11 hips. According to the Arlet and Ficat classification there were 10 stage I hips, 63 stage IIA and 17 stage IIB. Mean time to decompression was 3.5 years. We reviewed hips without a total prosthesis using the Postel-Merle-d’Aubigné function score and for the radiological assessment the Arlet and Ficatstage.

Results: Favorable outcome was noted in 64 hips. Total hip arthroplasty was required for 24 hips, Mean follow-up in the success group was 3.88 years. Mean survival after core decompression was 81% at 36 months. The only factor that influenced the results is the radiological stage preoperatively. The stage I hips did have more favorable outcome than the stage II hips (p<0.01). The other factors did not influence the results, namely sex, age and etiologies (P>0.5).

Conclusion: Epidemiological factors which can worsen outcome after core decompression for osteonecrosis are controversial in the literature. Early stage disease (I or II) is considered as an ideal indication for decompression, but is insufficient alone to guarantee success. Improved outcome after core decompression can only be achieved by limiting indications at beginner stages.