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Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 32-36

Evaluation of hip arthroscopy in patients with previous history of femoral head osteonecrosis

Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

Correspondence Address:
Dr. Amy P Trammell
Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/DORJ.DORJ_7_20

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Background: Femoral head osteonecrosis (FHO) is a debilitating condition. Free vascularized fibular grafting (FVFG) has good survivorship, however patients are at risk for reoperation. AIM and Objectives: This study compares patient characteristics, hip pathology, and surgical intervention in patients with FHO. We hypothesized that patients with FHO who underwent FVFG would demonstrate less severe degeneration of hip chondral surfaces compared to patients who did not. Materials and Methods: A database of 1,481 hip arthroscopies performed by a single surgeon was queried. Inclusion criteria included history of FHO. Patients with a previous hip surgery were excluded. Non-FVFG patients served as a control. Demographics, presentation, physical examination, imaging, intraoperative pathology, and procedures performed were compared. Cartilage degeneration was quantified with chondromalacia severity index (CMI). The Hip Outcome Score- Activity of Daily Living (HOS-ADL), -Sports Subscale (HOS-SS), and modified Hip Harris Score (mHHS) were calculated. Results: Sixteen patients had a history of FHO. Six (37.5%) previously underwent FVFG. Both groups had similar demographics, clinical presentation, preoperative range of motion, and radiographic findings (P>0.05). Arthroscopy identified similar chondral lesion Outerbridge grade and size for the acetabulum and femoral head (P>0.05). Compared with controls, FVFG patients had greater CMI of the acetabulum (844.7±501.3 vs. 345.8±433.3; P=0.018) and similar CMI of the femoral head (408. ±187.7 vs. 1461.0±1493.6; P=0.289). Microfracture of the acetabulum and ligamentum teres debridement were performed preferentially in patients with a history of FVFG compared with controls. Of the six previous FVFG patients, two converted to total hip arthroplasty, two completed patient reported outcomes, and two were lost to follow-up. Conclusion: Patients with previous FVFG for FHO are at an increased risk of chondral damage to the acetabulum and demonstrated more advanced chondral degeneration compared with controls. Level of Evidence: III; Retrospective cohort study

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