Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]

Safe surgical dislocation [SSD] for avascular
necrosis hip [AVN]
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DR MOHAMED ASHRAF ,PROFESSOR
DR JYOTHIS GEORGE,ASSISTANT
PROFESSOR
GOVT TD MEDICAL COLLEGE
ALLEPPEY,KERALA,INDIA
drashraf369@gmail.com

MICROCORE
DECOMPRESSION AND
BISPHOSPHONATE
INFILTRATION BY
SAFE SURGICAL
DISLOCATION FOR
AVN HIP

AVN
 Disabling disease
 Leads to destruction of the hip joint
Both the Diagnosis and appropriate
treatment poses difficulty in the minds of
all orthopaedic surgeons

• Once the disease has advanced some efforts must be taken to delay
– speed of progression of collapse
– total hip replacement.
• In young adults in their 20's-40's arthroplasty is best deferred as
much as possible

• Non surgical treatment modalities for the
preservation of necrotic femoral head have been
very time consuming and uniformly unsuccessful

Role of Core decompression who have cystic changes in
the femoral head on xray ?

• Jones analyzed nine studies and showed core
decompression performed in the precollapse stage,
failed to prevent the progressive collapse(in 218 of
369 patients (59%)
» American Academy of Orthopaedic Surgeons; 1994. p.
499-512
• What % collapse in core
decompression?

multiple drilling is safer and less invasive than single coring in SCD,
significantly longer time before the collapse (mean 42.3 months vs. 22.6
months, P = 0.011) and the lower rate of collapse within 3 years after
operation (55.0% vs. 85.7%)

• TECHNIQUE
• 3.2MM DRILL BIT

• Reduction in the rate of collapse

Suppresses biochemical markers of bone
resorption ------1 year

MULTIPLE DRILLING
+
BISPHOSPHONATE
=
 91% of patients with Stage II disease and 62% of patients with
Stage III disease had not required THA in alendronate group

DATA
• Age group of 33 -51 year
• Study period 2013 -2018
• Prospective, non randomised method with 2 years follow up done
• 42 patients with modified Ficat and Arlet stage II AVN hip were
studied.
• 29 patients were managed with CD and 13 patients with MCD with
intralesional bisphosphonate infiltration via ganz SSD of hip.
• The functional (Harris hip score) and radiological outcome is
assessed every 6 months.

• Out of 42 cases, 2 patients managed by CD and 1 patient in
MCD with intralesional bisphosphonate infiltration failed to
followup

SIDE
19
15
8
SIDE
LEFT
RIGHT
BILATERAL

81
19
STEROID INTAKE
ABSENT
PRESENT

61.9
38.1
SMOKING
PRESENT
ABSENT

ALCOHOL INTAKE
54.8
45.2 PRESENT
ABSENT

0
10
20
30
40
50
CAD CKD COPD DLP DM HTN NIL
COMORBIDITIES
COMORBIDITIES

69
31
SURGICAL PROCEDURE
CORE DECOMPRESSION
SSD+MCD+BISPHOSPHO
NATE

DELAYED TROCHANTER UNION (3
MONTHS)

13 OUT OF 29 PATIENTS IN CD GROUP HAD
RADIOLOGICAL PROGRESSION OF DISEASE AT
2 YEARS

FUNCTIONAL OUTCOME
CD SSD+MCD+BISPHOSPHONATE

0
10
20
30
40
50
60
70
80
90
100
CORE DECOMPRESSION
SSD+MCD+BISPHOSPH

CONCLUSION
• SSD provides 360 axis view to femoral head and acetabulum
• MCD addresses peripheral and central lesions
• Radiological transformation of femoral head is noted in MCD
group.
• MCD curbs disease progression on long term follow up.
• Core decompression had better Harris hip score on short term
follow up but on long term follow up MCD had superior results.
• Needs future follow up.

Addressing the pathology at micro level??

Remove the structural stability???

Answer:
• MICROCORE DECOMPRESSION
AND BISPHOSPHONATE
INFILTRATION BY SAFE
SURGICAL DISLOCATION

References:
1 The Journal of bone and journal of surgery
2 American academy of orthopaedic surgeons
3 Campbell’s operative orthopaedics
Statististical analysis: Dr Sreelal P ( Assosciate Prof, Department of Community Medicine,
AIMS,Kochi)

Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]

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