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DoModernTechniquesImproveCoreDecompressionOutcomesforHipOsteonecrosis?,2011-09-13,ContentIntroduction,Journal:ClinOrthopRelatResIF:2.116Publishedyear:2008Author:FromSinaiHospitalofBaltimoreUSASystematicReview,Abstract,Object:todeterminewhethertheefficacyimprovedduringthelast15yearsMethod:paredthesuccessratesbefore1992VS1992-20072.evaluatedtheoutcomesofour52patients(79hips)treatedwithmultiplesmall-diameterdrillings.Result:1.decreaseinadditionalsurgeriesandincreaseinradiographicsuccess2.smalllesionsandFicatStageIhadthebestresultswith79%noradiographicprogressionConclusion:coredecompressionisasafeandeffectiveprocedure,Questions,1.whethertheefficacyofcoredecompressionhasimprovedduringthelast15years?2.whethermoderntechniquesprovidebetteroutcomesthanthosenon-operativetreatment?3.whethertheoutcomestreatedusingsmall-diameterdrillingweresimilartoothermodernstudies?4.whetherpatientslessradiographicprogressionandsmallerlesionsizesusingsmalldiameterdrillingwouldbelesslikelytohavepooroutcomes?,Inclusioncriteria,1.providedradiographicoutcomesand/orindicatedwhetherpatientsunderwentadditionalsurgeries2.Onlythemostrecentstudieswereincludedatmultipletimesatdifferentfollowups3.theuseofancillarycancellousbonegrafting4.previouslyunpublishedresultsatourinstitutiontreatedusingasmall-diameterdrilling,Exclusioncriteria,1.notprovidesufficientdatatoanalyzeoutcomes2.fewerthan10patients3.Patientsyoungerthan18yearsold4.usedlongcorticalstrutbonegraftingorvascularizedbonegrafting5.ameanfollowupoflessthan18months,Criteriaforassessingeffectiveness,Pre-1992studies(23),1992to2007studies(26),historicalVSmodernstudies,Nonoperativetreatment(18),Multiplesmall-diameterdrillingVSotherstudies,Results-1,thesuccessrateswerehigherforthestudiesduringthelast15yearscomparedtobefore19921.Withoutadditionalsurgeryfrom59%to70%(p0.001)2.radiographicsuccessincreasedfrom56%to63%(p0.05)3.fewerpatientswhowereFicatStageIIIafter1992(p0.001),Results-2,higherproportionsoffailuresnonoperativetreatmentVSthecoredecompressionstudiesfrom1992to20071.underwentsurgeryatameanof67%VS30%(p0.001)2.radiographicfailureratesat72%VS37%(p0.001),Results-3,thesmall-diameterdrillingtechniqueresultssimilartootherstudiesofthelast15yearshigherFicatstagesandlargerlesionsizeshadincreasedfailureratespatientswhohadsmalllesionsandFicatStageIwith79%ofthesehipsshowingnoradiographicstageprogression,Limitsofthestudy,thesmallnumbersofpatientsinmanyofthereportsitwasdifficulttodeterminewhenthecoredecompressionswereperformedtostratifythestudyonlymidtermmeanfollowups(range,18monthsto144months),andthelong-termoutcomeisunclearthelevelofevidenceforthescientificliteraturelackofprospectiverandomizedmulticenterstudies,Conclusions,Recenttechniquesprovidebetterclinicalscoresorradiographicoutcomesthanpre-1992studies.However,itisunclearwhetherthisimprovementisduetoimprovedpatientselectionorsurgicaltechnique.CoredecompressionisasafeandeffectiveprocedurefortheearlystagesofONFH.Wewillusecoredecompressiontotreatpatientswhohaveearlysmall-andmedium-sizedlesionsandareFicatStageIorII.,advantagesforthesmall-diameterdrilling,(1)moreeasilyreachtheanteriorportionofthefemoralhead,(2)thereisminimalmorbidity;(3)reducedtheriskofweakeningorpenetratingthefemoralheadandinjuringthearticularcartilage(4)reducedtheriskofstressrisersthatcanleadtoasubtrochantericfracture,Learningexeperience,1.thesuccessrateswerehigherforthestudiesduringthelast15yearscomparedtobefore1992whetherthisimprovementisduetoimprovedpatientselectionorsurgicaltechnique.2.higherproporti

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