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Femur Başı Avasküler Nekroz Zemininde Total Kalça Protezi Yapılmış Olgularda Erken Dönem Sonuçlar

Year 2020, Volume: 73 Issue: 3, 266 - 269, 27.10.2020

Hakan Kocaoğlu

Abstract

Amaç: Femur başı avasküler nekrozu (FBAVN), proksimal femura kan akışının bozulması nedeniyle oluşan bir tür osteonekrozdur. FBAVN hastalarında
%30’dan fazla femur başında çökme ve koksartroz görülmektedir ve bu grupta tek kalıcı tedavi kalça artroplastisidir. Yaşı, demografik özellikleri ve
aktivite durumu ileri yaş kalça artroplasti hastalarından çok farklı olan bu özel grubun operasyon sonrası sonuçları literatürde genellikle ayrıntılı
olarak incelenmemiştir. Biz bu çalışma ile merkezimizde FBAVN zemininde gelişen koksartroz için TKP uygulanan hastaların demografisini inceledik.
Gereç ve Yöntem: 2015-2018 yılları arasında 4. basamak üniversite ortopedi ve travmatoloji kliniğinde, FBAVN etiyolojisi nedeniyle total kalça
protezi (TKP) cerrahisi gerçekleştirilmiş hastaların demografik bilgileri, eşlik eden hastalıkları, steroid ilaç kullanım hikayeleri, sigara öyküsü (paket/
yıl), cerrahi öncesi direkt grafi ve manyetik rezonans görüntüleme kesitleri, cerrahi sonrası 1. yıla kadar olan komplikasyonları ve direkt grafileri
incelenmiştir. Ayrıca hastaların cerrahi öncesi ve sonrası son kontrolde kalça fonksiyonel durumlarını incelemek için Harris kalça skoru (HKS)
karşılaştırılmıştır.

Bulgular: Yaş ortalaması 42,1±11,6 yıl olan toplam 44 hastanın 34’ü (%77,3) erkek 10’u (%22,7) kadındı. Hastaların 14’ünde (%32) sigara içme
öyküsü mevcut iken 22 (%50) hastada steroid ilaç kullanma hikayesi mevcuttur. Hastaların 17’sinde FBAVN bilateral tespit edilmiş olup dört hastada
her iki kalça da artroz nedeniyle değişik zamanlarda opere edilmiştir. Cerrahi sonrası ortalama takip süresi 19±7 (12-37) ay olarak tespit edilmiştir.
Hastaların cerrahi öncesi değerlendirilen HKS ortalama değerleri 59,6 (±7,7) iken ameliyat sonrası son takipte ölçülen HKS skorları 95,8 (±7,1) olarak
tespit edilmiştir. Hastaların fonksiyonel kalça skorları anlamlı olarak iyileşmiştir (p=0,003).

Sonuç: İleri evre FBAVN varlığında uygun şekilde yapılmış olan TKP güvenli ve başarılı bir yöntemdir. Hastaların ağrıları belirgin olarak azalma
göstermekte ve fonksiyonel sonuçları iyileşme göstermektedir.

Keywords

Osteonekroz Artroplasti Kalça

Ethical Statement

Ankara Üniversitesi Tıp Fakültesi Etik Kurul’undan onay alınmıştır (karar no: İ4-235-20, tarih: 29.04.2020).

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Petek D, Hannouche D, Suva D, “Osteonecrosis of the femoral head: Pathophysiology and current concepts of treatment,” EFORT Open Rev. 2019;4:85-97.
  • 2. Matthews A, Stitson D, Osteonecrosis. (Avascular Necrosis) (Updated 2020 Jan 20). In StatPearls, Treasure Island (FL): StatPearls Publishing, 2020, (Internet).
  • 3. Baig SA, Baig M, “Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management,” Cureus. 2018. DOI: doi.org/10.7759%2Fcureus.3171
  • 4. Xie XH, Wang XL, Yang HL, et al. Steroid-associated osteonecrosis: Epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview). J. Orthop. Transl. 2015;3:58-70.
  • 5. Jaffré C, Rochefort GY. Alcohol-induced osteonecrosis - dose and duration effects. Int. J. Exp. Pathol. 2012;93:78-79.
  • 6. Jawad MU, Haleem AA, Scully SP. In brief: Ficat classification: Avascular necrosis of the femoral head. Clin Orthop Relat Res. 2012;470:2636-2639.
  • 7. Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Jt Surg Am Vol. 2014;97:1604-1627.
  • 8. Min BW, Song KS, Cho CH, et al. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 2008;466:1087-1092.
  • 9. Baek SH, Kim SY. Cementless Total Hip Arthroplasty with Alumina Bearings in Patients Younger Than Fifty with Femoral Head Osteonecrosis. JBJS. 2008;90:1314-1320.
  • 10. Guerado E, Caso E. The physiopathology of avascular necrosis of the femoral head: an update. Injury. 2016;47:S16-S26.
  • 11. Talmaç MA. The Results Of Core Decompression Treatment In Femoral Head Avascular Necrosis. Med Bull Sisli Hosp. 2018;52:249-253.
  • 12. Kim YH, Oh SH, Kim JS, et al. Contemporary Total Hip Arthroplasty with and without Cement in Patients with Osteonecrosis of the Femoral Head. JBJS. 2003;85:675-681.
  • 13. Osawa Y, Seki T, Takegami Y, et al. Cementless total hip arthroplasty for osteonecrosis and osteoarthritis produce similar results at ten years followup when matched for age and gender. Int Orthop. 2018;42:1683-1688.
  • 14. Ortiguera CJ, Pulliam IT, Cabanela ME. Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term followup. J Arthroplasty. 1999;14:21-28.
  • 15. Ancelin D, Reina N, Cavaignac E, et al. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Casecontrol study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res. 2016;102:1029-1034.
  • 16. Cornell CN, Salvati EA, Pellicci PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North Am. 1985;16:757-769.

Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip

Year 2020, Volume: 73 Issue: 3, 266 - 269, 27.10.2020

Hakan Kocaoğlu

Abstract

Objectives: Avascular necrosis (AVN) of the femoral head is a type of osteonecrosis caused by impaired blood flow to the proximal femur. Femoral head collapse and coxarthrosis are seen in more than 30% of the patients with AVN of femur, and the only definitive treatment in this group is hip arthroplasty (THA). The post-operative results of this distinct cohort, whose age, demographic characteristics and activity status are very different from advanced age hip arthroplasty patients, have not been generally studied in the literature. With this study, we aimed to examine the demography and early results and complications of patients who underwent THA for coxarthrosis developing on the basis of AVN of the femur in our center.

Materials and Methods: Demographic data, comorbidities, corticosteroid and smoking history of patients who underwent THA due to the etiology of AVN in the 4th stage-university orthopedics and traumatology clinic between 2015 and 2018 were evaluated, preoperative X-rays and magnetic resonance images, postoperative 1st year complications were evaluated. In addition, the Harris hip score (HHS) was compared to examine the hip functional status of patients before and after the surgery.

Results: The mean age of 44 patients was 42.1±11.6 years, and 34 (77.3%) were male and 10 (22.7%) were female. While 14 (32%) of the patients had a smoking history, 22 (50%) patients had a history of using corticosteroid drugs. In 17 patients, AVN was bilaterally, and in four patients both hips were operated at different times due to arthrosis. The mean follow-up period after the surgery was 19±7 (12-37) months. HHS mean value of the patients evaluated preoperatively was 59.6 (±7.7), while the mean HHS score measured at the last postoperative follow-up was 95.8 (±7.1). Functional hip scores of patients improved significantly (p=0.003).

Conclusion: THA, which has been performed in the presence of advanced AVN of the femur, is a safe and successful method. The pain of patients decreases significantly, and their functional results improve.

Keywords

Osteonecrosis Arthroplasty Hip

Ethical Statement

-

Supporting Institution

-

Project Number

-

Thanks

-

References

  • 1. Petek D, Hannouche D, Suva D, “Osteonecrosis of the femoral head: Pathophysiology and current concepts of treatment,” EFORT Open Rev. 2019;4:85-97.
  • 2. Matthews A, Stitson D, Osteonecrosis. (Avascular Necrosis) (Updated 2020 Jan 20). In StatPearls, Treasure Island (FL): StatPearls Publishing, 2020, (Internet).
  • 3. Baig SA, Baig M, “Osteonecrosis of the Femoral Head: Etiology, Investigations, and Management,” Cureus. 2018. DOI: doi.org/10.7759%2Fcureus.3171
  • 4. Xie XH, Wang XL, Yang HL, et al. Steroid-associated osteonecrosis: Epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview). J. Orthop. Transl. 2015;3:58-70.
  • 5. Jaffré C, Rochefort GY. Alcohol-induced osteonecrosis - dose and duration effects. Int. J. Exp. Pathol. 2012;93:78-79.
  • 6. Jawad MU, Haleem AA, Scully SP. In brief: Ficat classification: Avascular necrosis of the femoral head. Clin Orthop Relat Res. 2012;470:2636-2639.
  • 7. Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: Where do we stand today? A ten-year update. J Bone Jt Surg Am Vol. 2014;97:1604-1627.
  • 8. Min BW, Song KS, Cho CH, et al. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res. 2008;466:1087-1092.
  • 9. Baek SH, Kim SY. Cementless Total Hip Arthroplasty with Alumina Bearings in Patients Younger Than Fifty with Femoral Head Osteonecrosis. JBJS. 2008;90:1314-1320.
  • 10. Guerado E, Caso E. The physiopathology of avascular necrosis of the femoral head: an update. Injury. 2016;47:S16-S26.
  • 11. Talmaç MA. The Results Of Core Decompression Treatment In Femoral Head Avascular Necrosis. Med Bull Sisli Hosp. 2018;52:249-253.
  • 12. Kim YH, Oh SH, Kim JS, et al. Contemporary Total Hip Arthroplasty with and without Cement in Patients with Osteonecrosis of the Femoral Head. JBJS. 2003;85:675-681.
  • 13. Osawa Y, Seki T, Takegami Y, et al. Cementless total hip arthroplasty for osteonecrosis and osteoarthritis produce similar results at ten years followup when matched for age and gender. Int Orthop. 2018;42:1683-1688.
  • 14. Ortiguera CJ, Pulliam IT, Cabanela ME. Total hip arthroplasty for osteonecrosis: matched-pair analysis of 188 hips with long-term followup. J Arthroplasty. 1999;14:21-28.
  • 15. Ancelin D, Reina N, Cavaignac E, et al. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Casecontrol study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res. 2016;102:1029-1034.
  • 16. Cornell CN, Salvati EA, Pellicci PM. Long-term follow-up of total hip replacement in patients with osteonecrosis. Orthop Clin North Am. 1985;16:757-769.
There are 16 citations in total.

Details

Primary Language English
Subjects Orthopaedics
Journal Section Articles
Authors

Hakan Kocaoğlu 0000-0002-1421-3555

Project Number -
Publication Date October 27, 2020
Published in Issue Year 2020 Volume: 73 Issue: 3

Cite

APA Kocaoğlu, H. (2020). Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 73(3), 266-269. https://doi.org/10.4274/atfm.galenos.2020.92905
AMA Kocaoğlu H. Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip. Ankara Üniversitesi Tıp Fakültesi Mecmuası. October 2020;73(3):266-269. doi:10.4274/atfm.galenos.2020.92905
Chicago Kocaoğlu, Hakan. “Short-Term Results of Total Hip Arthroplasty Cases With Osteonecrosis of the Hip”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 73, no. 3 (October 2020): 266-69. https://doi.org/10.4274/atfm.galenos.2020.92905.
EndNote Kocaoğlu H (October 1, 2020) Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip. Ankara Üniversitesi Tıp Fakültesi Mecmuası 73 3 266–269.
IEEE H. Kocaoğlu, “Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 73, no. 3, pp. 266–269, 2020, doi: 10.4274/atfm.galenos.2020.92905.
ISNAD Kocaoğlu, Hakan. “Short-Term Results of Total Hip Arthroplasty Cases With Osteonecrosis of the Hip”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 73/3 (October 2020), 266-269. https://doi.org/10.4274/atfm.galenos.2020.92905.
JAMA Kocaoğlu H. Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;73:266–269.
MLA Kocaoğlu, Hakan. “Short-Term Results of Total Hip Arthroplasty Cases With Osteonecrosis of the Hip”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 73, no. 3, 2020, pp. 266-9, doi:10.4274/atfm.galenos.2020.92905.
Vancouver Kocaoğlu H. Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2020;73(3):266-9.
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