Arthroscopic management and platelet-rich plasma therapy for avascular necrosis of the hip

Purpose The purpose is to describe a noninvasive arthroscopic procedure as an alternative to open surgery for avascular necrosis of the hip. Methods Patients with grade I or IIA avascular necrosis of the hip are treated by core decompression performed by drilling under fluoroscopic guidance. Liquid...

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Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2012-02, Vol.20 (2), p.393-398
Main Authors: Guadilla, Jorge, Fiz, Nicolas, Andia, Isabel, Sánchez, Mikel
Format: Article
Language:English
Subjects:
Arthroscopy - methods
Blood platelets
Bone Transplantation - methods
Cartilage
Debridement
Decompression, Surgical
Drilling
Femur Head Necrosis - diagnosis
Femur Head Necrosis - surgery
Fibrin - administration & dosage
Hip
Humans
Magnetic resonance imaging
Medicine
Medicine & Public Health
Necrosis
Orthopedics
Plasma
Platelet-Rich Plasma
Skin & tissue grafts
Surgery
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Summary:Purpose The purpose is to describe a noninvasive arthroscopic procedure as an alternative to open surgery for avascular necrosis of the hip. Methods Patients with grade I or IIA avascular necrosis of the hip are treated by core decompression performed by drilling under fluoroscopic guidance. Liquid platelet-rich plasma (PRP) is delivered through a trocar, saturating the necrotic area. In more severe conditions, the necrotic bone is decompressed and debrided, through a cortical window at the head–neck junction. A composite graft made of autologous bone and PRP is delivered by impactation through the core decompression track. Fibrin membranes are applied to enhance healing of the head–neck window and arthroscopic portals. Platelet-rich plasma is infiltrated in the central compartment. Results This arthroscopic approach aids in making diagnosis of the labrum and articular cartilage and permits intra-operative treatment decisions. Visual control permits the precise localization and treatment for the necrotic area allowing cartilage integrity to be preserved. Conclusions Arthroscopic management of avascular necrosis of the femoral head is viable and has significant advantages. Clinical studies should justify the theoretical additional benefits of this approach.
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-011-1587-9