Avascular necrosis of the femoral head in young adults - a double-stage solution with forage and remodeling osteochondroplasty
Abstract
Avascular necrosis of the femoral head remains despite significant advances in medicine, an important pre-arthritis. Attitudes on the indication for a surgical procedure and its radicalism (joint-preserving procedure vs. arthroplasty) are different and changing.
During the initial collapse of the head and an uncertain prognosis quod vitam, the indication for total hip replacement can be provided also in the end of the second decade relatively generous. But for patients who are in remission of a systemic disease, this can be considered critical even on the border of the third or fourth decade.
Because of its simplicity, low morbidity and a good analgesic effect the removal of necrotic areas with a following autologous bone grafting is recommended in such cases. For further functional problems or pain after this surgery a femoroacetabular impingement syndrome must be excluded, which should be treated by open dislocation of the hip.
However, the indication for any osteotomy should be made cautiously. They deteriorate the anatomy at the upper end of the femur and thus the conditions for the implantation of an endoprosthesis, which ultimately often cannot be prevented.