A comparative study on the clinical effectiveness of core decompression with bone grafting for treating alcohol-induced and traumatic osteonecrosis of the femoral head: a population-specific investigation in alcoholism.

Análisis comparativo de la eficacia clínica de la descompresión central combinada con injerto óseo en el tratamiento de la osteonecrosis traumática o inducida por alcohol de la cabeza femoral.

• Zhensong Wu School of Medicine, Shandong University, Jinan, China https://orcid.org/0009-0009-2940-0781
• Da Song Department of Joint Surgery, Liaocheng People’s Hospital Affiliated to Shandong University, Liaocheng, China. https://orcid.org/0009-0004-2242-2498
• Qi Xu Department of Joint Surgery, Liaocheng People’s Hospital Affiliated to Shandong University, Liaocheng, China. https://orcid.org/0009-0001-5704-582X
• Dawei Wang Department of Joint Surgery, Liaocheng People’s Hospital Affiliated to Shandong University, Liaocheng, China. https://orcid.org/0009-0001-4508-790X

DOI: https://doi.org/10.54817/IC.v65n3a02

Palabras clave: descompresión central, injerto óseo, osteonecrosis traumática de la cabeza femoral, osteonecrosis inducida por alcohol de la cabeza femoral

Resumen

La osteonecrosis de la cabeza femoral (ONFH) es una afección ortopédica clasificada en dos categorías principales: osteonecrosis traumática (TON-FH) y osteonecrosis no traumática, incluida la osteonecrosis inducida por alcohol (AIONFH). Un estudio con 50 pacientes (25 AIONFH, 25 TONFH) sometidos a descompresión central con injerto óseo evaluó su eficacia y factores influyentes. La edad promedio fue de 47,2 años, con un 72% de hombres y el seguimiento promedio fue de 16,62 meses. Los pacientes con AIONFH tenían un IMC más alto y más co-morbilidades como diabetes, hiperlipidemia, hipertensión y enfermedades inmuno-lógicas. La TONFH tenía una mayor prevalencia de osteoporosis y antecedentes de fracturas. La necrosis bilateral de cadera fue más frecuente en la TONFH, mientras que la necrosis de cadera izquierda dominaba en la AIONFH. Ambos grupos tenían principalmente clasificaciones JIC C1 y C2. Preoperatoriamente, la mayoría de los casos eran de grado ARCO III y IV, con puntajes de Harris, PCS y MCS más bajos. A los 6 meses de la evaluación posoperatoria, ambos grupos mejoraron, con resultados superiores en la AIONFH. El seguimiento promedio fue de 16,62 meses. En la última evaluación de seguimiento, la mayoría de los casos de AIONFH eran del tipo ARCO I, y los puntajes de HHS, PCS y MCS fueron significativamente mejores que en la TONFH. La descompresión central con injerto óseo trata eficazmente ambas categorías de ONFH, con resultados superiores en la AIONFH. Los factores que influyen en la eficacia posoperatoria incluyen el IMC, la clasificación JIC y el puntaje PCS. Estos hallazgos informan sobre la adaptación de las estrategias de tratamiento a las categorías de ONFH.

Citas

Yue J, Gao H, Guo X, Wang R, Li B, Sun Q, Liu W, Chen J, Li Y. Fibula allograft propping as an effective treatment for early-stage osteonecrosis of the femoral head: a systematic review. J Orthop Surg Res 2020; 15(1):206. doi: 10.1186/ s13018-020-01730-6.

Yan Z, Zhan J, Qi W, Lin J, Huang Y, Xue X, Pan X. The protective effect of luteolin in glucocorticoid-induced osteonecrosis of the femoral head. Front Pharmacol 2020; 11:1195. doi: 10.3389/fphar.2020.01195.

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

Tan B, Li W, Zeng P, Guo H, Huang Z, Fu F, Gao H, Wang R, Chen W. Epidemiological study based on China osteonecrosis of the Femoral Head Database. Orthop Surg 2021; 13(1):153-160. doi: 10.1111/ os.12857.

Konarski W, Poboży T, Śliwczyński A, Kotela I, Krakowiak J, Hordowicz M, Kotela Avascular necrosis of femoral head-Over-view and current state of the art. Int J Environ Res Public Health. 2022;19(12):7348. doi: 10.3390/ijerph19127348.

Hines JT, Jo WL, Cui Q, Mont MA, Koo KH, Cheng EY, Goodman SB, Ha YC, Hernigou P, Jones LC, Kim SY, Sakai T, Sugano N, Yamamoto T, Lee MS, Zhao D, Drescher W, Kim TY, Lee YK, Yoon BH, Baek SH, Ando W, Kim HS, Park JW. Osteonecrosis of the femoral head: an updated review of ARCO on pathogenesis, staging and treatment. J Korean Med Sci. 2021;36(24):e177. doi: 10.3346/ jkms.2021.36.e177.

Wu P, Xiao Y, Qing L, Tang J, Huang C, Cao Z. Comparison of retrograde anatomy iliac bone flap grafting versus anterograde anatomy iliac bone flap grafting for treatment of osteonecrosis of the femoral head. J Orthop Surg Res 2023; 18(1):130. doi: 10.1186/s13018-023-03617-8.

Sai Krishna MLV, Kar S, Kumar R, Singh H, Mittal R, Digge VK. The role of conservative management in the avascular necrosis of the femoral head: A review of systematic reviews. Indian J Orthop. 2023;57(3):410-420. doi: 10.1007/s43465-023-00818-5.

Singh M, Singh B, Sharma K, Kumar N, Mastana S, Singh P. A molecular troika of angiogenesis, coagulopathy and endothelial dysfunction in the pathology of avascular necrosis of femoral head: A comprehensive review. Cells. 2023 ;12(18):2278. doi: 10.3390/cells12182278.

Anand A, Jha CK, Singh PK, Sinha U, Ganesh A, Bhadani PP. Avascular necrosis of femur as a complication of Cushing’s syndrome due to adrenocortical carcinoma. Am Surg. 2023;89(6):2701-2704.

Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. Efort Open Rev 2019; 4(3):85-97. doi: 10.1302/2058-5241.4.180036.

Zhu S, Zhang X, Chen X, Wang Y, Li S, Qian W. Comparison of cell therapy and other novel adjunctive therapies combined with core decompression for the treatment of osteonecrosis of the femoral head: a systematic review and meta-analysis of 20 studies. Bone Joint Res 2021; 10(7):445-458. doi: 10.1302/2046-3758.107.BJR-2020-0418.R1.

Mont MA, Salem HS, Piuzzi NS, Goodman SB, Jones LC. Nontraumatic osteo-necrosis of the femoral head: where do we stand today?: A 5-year update. J Bone Joint Surg Am 2020; 102(12):1084-1099. doi: 10.2106/JBJS.19.01271.

Yoon BH, Mont MA, Koo KH, Chen CH, Cheng EY, Cui Q, Drescher W, Gangji V, Goodman SB, Ha YC, Hernigou P, Hungerford MW, Iorio R, Jo WL, Jones LC, Khanduja V, Kim H, Kim SY, Kim TY, Lee HY, Lee MS, Lee YK, Lee YJ, Nakamura J, Parvizi J, Sakai T, Sugano N, Takao M, Yamamoto T, Zhao DW. The 2019 Revised Version of Association Research Circulation Osseous Staging System of Osteonecrosis of the Femoral Head. J Arthroplasty 2020; 35(4):933-940. doi: 10.1016/j. arth.2019.11.029.

Peng WX, Ye C, Dong WT, Yang LL, Wang CQ, Wei ZA, Wu JH, Li Q, Deng J, Zhang J. MicroRNA-34a alleviates steroid-induced avascular necrosis of femoral head by targeting Tgif2 through OPG/ RANK/RANKL signaling pathway. Exp Biol Med 2017; 242(12):1234-1243. doi: 10.1177/1535370217703975.

Algarni AD, Al MH. Clinical and radiological outcomes of extracorporeal shock wave therapy in rarly-stage femoral head osteo-necrosis. Adv Orthop 2018; 2018:7410246. doi: 10.1155/2018/7410246.

Zhao Y, Zhang G, Song Q, Fan L, Shi Z. Intramedullary core decompression combined with endoscopic intracapsular decompression and debridement for pre-collapse non-traumatic osteonecrosis of the femoral head. J Orthop Surg Res 2023; 18(1):6. doi: 10.1186/s13018-022-03477-8.

Larson E, Jones LC, Goodman SB, Koo KH, Cui Q. Early-stage osteonecrosis of the femoral head: where are we and where are we going in year 2018? Int Orthop 2018; 42(7):1723-1728. doi: 10.1007/ s00264-018-3917-8.

Li G, Li B, Li B, Zhao J, Wang X, Luo R, Li Y, Liu J, Hu R. The role of biomechanical forces and MALAT1/miR-329-5p/ PRIP signaling on glucocorticoid-induced osteonecrosis of the femoral head. J Cell Mol Med 2021; 25(11):5164-5176. doi: 10.1111/jcmm.16510.

Ma JX, Kuang MJ, Fan ZR, Xing F, Zhao YL, Zhang LK, Chen HT, Han C, Ma XL. Comparison of clinical outcomes with InterTan vs Gamma nail or PFNA in the treatment of intertrochanteric fractures: A meta-analysis. Sci Rep-Uk 2017; 7(1):15962. doi: 10.1038/s41598-017-16315-3.

Jayasinghe UW, Harris MF, Taggart J, Christl B, Black DA. Gender differences in health-related quality of life of Australian chronically-ill adults: patient and physician characteristics do matter. Health Qual Life Out 2013; 11:102. doi: 10.1186/1477-7525-11-102.

Bachiller FG, Caballer AP, Portal LF. Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat R 2002(399):87-109. doi: 10.1097/00003086-200206000-00012.

Qin X, Jin P, Jiang T, Li M, Tan J, Wu H, Zheng L, Zhao J. A Human chondrocyte-derived in vitro model of alcohol-induced and steroid-induced femoral head necrosis. Med Sci Monitor 2018; 24:539-547. doi: 10.12659/msm.907969.

Liu Y, Zhao D, Wang W, Zhang Y, Wang B, Li Z. Efficacy of core decompression for treatment of canine femoral head osteonecrosis induced by arterial ischaemia and venous congestion. Hip Int 2017; 27(4):406-411. doi: 10.5301/hipint.5000462.

Laimer J, Holler A, Pichler U, Engel R, Neururer SB, Egger A, Griesmacher A, Bruckmoser E. Nutritional status in patients with medication-related osteonecrosis of the jaw (MRONJ). Nutrients 2021; 13(5):1585. doi: 10.3390/nu13051585.

Gkastaris K, Goulis DG, Potoupnis M, Anastasilakis AD, Kapetanos G. Obesity, osteoporosis and bone metabolism. J Musculoskel Neuron 2020; 20(3):372-381.

Tan L, Long LZ, Ma XC, Yang WW, Liao FF, Peng YX, Lu JM, Shen AL, An DQ, Qu H, Fu CG. Association of body mass index trajectory and hypertension risk: A systematic review of cohort studies and network meta-analysis of 89,094 participants. Front Cardiovasc Med 2022; 9:941341. doi: 10.3389/fcvm.2022.941341.

Hosseinpanah F, Barzin M, Golkashani HA, Nassiri AA, Sheikholeslami F, Azizi F. Association between moderate renal insufficiency and cardiovascular events in a general population: Tehran lipid and glucose study. BMC Nephrol 2012; 13:59. doi: 10.1186/1471-2369-13-59.

Huang Z, Tan B, Ye H, Fu F, Wang R, Chen W. Dynamic evolution of osseous structure in osteonecrosis of the femoral head and dynamic collapse risks: a preliminary CT image study. J Orthop Surg Res 2020; 15(1):539. doi: 10.1186/s13018-020-02069-8.

Hong G, Huang X, Lv T, Li X. An analysis on the effect of the three-incision combined approach for complex fracture of tibial plateau involving the posterolateral tibial plateau. J Orthop Surg Res 2020; 15(1):43. doi: 10.1186/s13018-020-1572-4.

Wu Z, Wang B, Tang J, Bai B, Weng S, Xie Z, Shen Z, Yan D, Chen L, Zhang J, Yang L. Degradation of subchondral bone collagen in the weight-bearing area of femoral head is associated with osteoarthritis and osteonecrosis. J Orthop Surg Res 2020; 15(1):526. doi: 10.1186/s13018-020-02065-y.

Asada R, Abe H, Hamada H, Fujimoto Y, Choe H, Takahashi D, Ueda S, Kuroda Y, Miyagawa T, Yamada K, Tanaka T, Ito J, Morita S, Takagi M, Tetsunaga T, Kaneuji A, Inaba Y, Tanaka S, Matsuda S, Sugano N, Akiyama H. Femoral head collapse rate among Japanese patients with pre-collapse osteonecrosis of the femoral head. J Int Med Res 2021; 49(6):675883032. doi: 10.1177/03000605211023336.

Carta MG, Maggiani F, Pilutzu L, Moro MF, Mura G, Sancassiani F, Vellante V, Migliaccio GM, Machado S, Nardi AE, Preti A. Sailing can improve quality of life of people with severe mental disorders: results of a cross over randomized controlled trial. Clin Pract Epidemiol Ment Health 2014; 10:80-86. doi: 10.2174/1745017901410010080.