Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head

doi:10.1136/ard.56.12.747

Annals of the Rheumatic Diseases 1997;56:747-750; doi:10.1136/ard.56.12.747

Ann Rheum Dis 1997;56:747-750 ( December )

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Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head Bernard Mazières,^a Frédéric Marin,^a Philippe Chiron,^b Laurence Moulinier,^a Jean-Marc Amigues,^a Michel Laroche,^a Alain Cantagrel^a

^a Department of Rheumatology, University Hospital of Rangueil, Toulouse, France, ^b Department of Orthopaedic Surgery, University Hospital of Rangueil, Toulouse, France

Correspondence to: Professor B Mazières, Department of Rheumatology, University Hospital of Rangueil, 31054 - Toulouse Cedex, France.

Accepted for publication 22 September 1997

OBJECTIVES $---$ To assess the outcome of core decompression in the treatment of osteonecrosis of the femoral head related to the volume ofnecrotic bone measured according to a previously reportedmethod.
METHODS $---$ Twenty hips corresponding to strictly Ficat stage II underwent magnetic resonance imaging and the volume of necrotic bonewas expressed as a percentage of the volume of the entire headmeasured on each slice. All hips underwent core decompressionand the outcome was evaluated at 24 months. The primary evaluationcriterion was radiological appearance: the outcome was consideredas good if the hip remained stage II and poor if the diseaseprogressed.
RESULTS $---$ Twenty four months after core decompression, half the cases remained stable and in half the disease had progressed. Outcomeseemed to be related to the volume of necrotic bone (average 22%in the good outcome group versus 45% in the poor outcome group(p = 0.0051)) and was independent of risk factors, age, and histologicaltype.
CONCLUSIONS $---$ The volume of necrotic bone should be taken into account in the evaluation of any treatment, bearing in mind that in morethan one third of cases this volume will probably decrease, especiallyat the beginning of the diseaseprocess.

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