Early Diagnosis and Treatment

Aseptic necrosis of a femoral head - severe chronic orthopedic pathology (1.2-12 %), diagnostics of which presents considerable difficulties. Problems of fast diagnostics, identical clinical symptoms, rapid development of the disease leads to disability. Risk group includes young and middle-aged men. The cause of the disease is unknown, the possibilities of conservative treatment are applied only in the early stages with doubtful efficiency, and among surgical none is the best. The research is performed in the traumatology center of Khabarovsk - clinical base of a Postgraduate Institute for Public Health Workers. During 2014-2019, retrospective analysis of treatment results was carried out on the basis of statistical data of 97 medical maps of patients diagnosed with aseptic necrosis of a femoral head, pathomorphological study of 49 preparations of the femoral head; laboratory analysis of immunological indicators of cellular immunity and thyroid hormones in the operated group of patients was carried out. Detected immunological changes indicate the systemic nature of the disease. Method of minimally invasive two-stage decompression of femoral neck is developed. Minimum injury of the developed method of treatment provides undeniable advantages in contrast to previous methods of surgical treatment. The technique has been applied in 17 cases, with positive medium-term clinical results. Aseptic necrosis of a femoral head is a pathology with a polymorphologicpicture, diagnosis of which presents considerable difficulties, associated with high risk of development atyoung age, is a current problem and demands further studying for the purpose of achievement of permanent long remission, and, perhaps, and an absolute recovery of the patient.

1. Tikhilov RM, Shubniakov II, Myasoedov AA, Irzhanskiy AA. Comparative characteristic of results of treatment of early stages of osteonecrosis of femoral head by various methods of decompression. Travmatologiya i ortopediya Rossii. 2016; 22(3): 7-19. (In Russ.)

2. Bashkova IB, Madyanov IV. Multiple non-traumatic osteonecrosis of large joints in a young person, triggered by short-term treatment with glucocorticoids. Rus. med. zhurn. Revmatologiya. 2016; (2): 125-128. (In Russ.)

3. Mustafin RN, Khasnutdinova EK. Avascular necrosis of the femoral head (review of literature). Pacific Medical Journal. 2017; (1): 27-35. (In Russ.)

4. Blish OYu. Hip pain: modern ideas about the possibilities and role of various methods of radiation diagnosis in determining the causes of pain syndrome. Luchevaya diagnostika i terapiya. 2014; 2(5): 37-44. (In Russ.)

5. Bolshakov OP, Kornilov NV, Rasulov RM. The importance of functional and anatomical factors in the choice of the method of treatment of adults with aseptic necrosis of the femoral head and children with Legg - Calve - Pertes disease. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2007; (2): 27-31. (In Russ.)

6. Volkov EE, Vasilenko AM, Mezhov SE. Parameters of microcirculation in the zone of hip joints in healthy volunteers. Tromboz, gemostazireologiya. 2016: 2(66): 43-46. (In Russ.)

7. Guryev VV, Zorya VI, Sklyuchuk ED. Hip revascularization in persons with post-traumatic coxarthrosis of the initial stage. Mosk. khirurg. zhurn. 2011; 2(18): 44-48. (In Russ.)

8. Dubikov AI, Kabalyk MA, Petrikeeva TY. The phenomenon of cartilage microcrystalization in coxarthrosis and aseptic necrosis of the femoral head. Nauchno-prakticheskaya revmatologiya. 2012; 54(5): 37-41. (In Russ.)

9. Kovalenko AN, Akhtyamov IF. Etiology and pathogenesis of aseptic necrosis of femoral head. Geniy ortopedii. 2010; (2): 138-144. (In Russ.)

10. Mustafin RN. Aseptic necrosis of femoral head. Lechebnoe delo. 2015; (4): 7-20. (In Russ.)

11. Prokhorenko VM, Shusharin AG, Polovinka MP. Use of perfluorane in conservative treatment of initial stages of aseptic necrosis of femoral head. Vestnik travmatologii i ortopedii im. N.N. Priorova. 2015; (4): 26-31. (In Russ.)

12. Ding P, Zhang W, Tan Q, Yao C, Lin S. Impairment of circulating endothelial progenitor cells (EPCs) in patients with glucocorticoid-induced avascular necrosis ofthe femoral head and changes ofEPCs after glucocorticoid treatment in vitro. J Orthop Surg Res. 2019; 14(1): 226.

13. Fyodorov VG. Medium-term monitoring of bone plastic results in aseptic necrosis of femoral head. Mezhdunar. zhurnal priklad. i fundament. issledovaniy. 2015; (11): 689-693. (In Russ.)

14. Shusharin AG, Polovinka MP, Prokhorenko VM. Aseptic necrosis of femoral head: options ofconservative treatment and results. Scientific reviews. Fundamental research. 2014; 10: 428-435. (In Russ.)

15. Li SD. A comparative study on the measurement of femoral head necrosis lesions using ultra-thin layer slicing and computer aided identification. Zhongguo GuShang. 2016; 29(2): 131-135.

16. Guadilla N, Fiz AI, Sanchez M. Arthroscopic management and platelet-rich plasma therapy for avascular necrosis of the hip. Knee Surgery, Sports Traumatology, Arthroscopy. 2012; 20(2): 393-398.

17. Kumar S, Bansal D, Prakash M. Avascular necrosis of femoral head as the initial manifestation of CML. Oncology. 2014; 31(6): 568-573.

18. Miao Q. Expression of osteoprotegerin, RNAK and RANKL genes in femoral head avascular necrosis and related signaling pathway. Int J Clin Experim Pathol. 2015; 8(9): 10460-10467.

19. Houdek MT. Osteonecrosis ofthe femoral head: treatment with ancillary growth factors. Curr Rev Musculoskeletal Med. 2015; 8(3): 233-239.

20. Li PF. Downregulation of basic fibroblast growth factor is associated with femoral head necrosis in broilers. PoultSci. 2015; 94(5): 1052-1059.

21. Rempel DP, Bryukhanov AV, Batrak YuM. Possibility of radiation diagnostics of symmetrical joint injury in diagnosed aseptic femoral necrosis. Radiologiya -praktika. 2013; (6): 24-32. (In Russ.)

22. Li D. Alterations of sympathetic nerve fibers in avascular necrosis of femoral head. Int J Clin Exp Pathol. 2015; 8(9): 10947-10952.

23. Khazov PD, Kazakov SS. Magneto-resonance imaging in diagnosis of aseptic necrosis of femoral heads. Radiologiya -praktika. 2001; (4): 106-107. (In Russ.)

24. Manenti G. The role of imaging in diagnosis and management of femoral head avascular necrosis. J Italian Soc Osteoporosis. 2015; 12(1): 31-38.

25. Ghale-Noie ZN, Hassani M, Kachooei AR, Kerachian MA. High serum alpha-2-macroglobulin level in patients with osteonecrosis of the femoral head. Arch Bone JtSurg. 2018; 6(3): 219-224.

26. Kawai K., Tamaki A, Hirohata K. Steroid-induced accumulation of lipid in the osteocytes of the rabbit femoral head. A histochemical and electron microscopic study. Surgery. 1985; 5(67-A): 755-763.

27. Shusharin AG, Polovinka MP, Prokhorenko VM. Treatment of hip joint aseptic necrosis using local injection therapy under ultrasound control. Institut khimicheskoy biologi i fundamentally meditsiny. 2012; (4): 32. (In Russ.)

28. Huang SL. Hydrogen-rich saline attenuates steroid-associated femoral head necrosis through inhibition of oxidative stress in a rabbit model. China. Spandidos. 2016; (1): 1792-0981.

29. Fang J. Effects of leucocyte- and platelet-rich plasma on osteogenic differentiation of bone marrow mesenchymal stem cells in treating avascular necrosis of femoral head in rabbits. Zho Xi F Ch Ji. 2015; 29(2): 227-233.

30. Fang J. Effects of leucocyte and platelet - rich plasma on osteogenic differentiation of bone marrow mesenchymal stem cells in treating avascular necrosis of femoral head in rabbits. J Ch. 2015; (1): 1002-1892.

31. Matsusaki H, Noguchi M, Kawakami T. Use of vascularized pedicle iliac bone graft combined with transtrochanteric rotational osteotomy in the treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 2005; 125(2): 95-101.

32. Liu X. Treatment of bilateral avascular necrosis of femoral head by free vascularized fibula grafting with unilateral fibula as donor. Zho Xi F Ch Ji W. 2011; 25(6): 641-645.

33. Beck DM. Arthroscopic treatment of labral tears and concurrent avascular necrosis of the femoral head in young adults. Arthroscopy Techniques. 2013; 2(4): 367-371.

34. Guo HS, Tian YJ, Liu G, An L, Zhou ZG, Liu HZ. Arthroscopy-guided core decompression and bone grafting combined with selective arterial infusion for treatment of early stage avascular necrosis of femoral head. Zho GuSha. 2018; 31(1): 56-61.

35. Li J, Li ZL, Zhang H, Su XZ, Wang KT, Yang YM. Long-term outcome of multiple small-diameter drilling decompression combined with hip arthroscopy versus drilling alone for early avascular necrosis of the femoral head. Chin Med J. 2017; 130(12): 1435-1440.

36. Akhtyamov IF, Anisimov OG, Kovalenko AN. Prevention of early hip arthroplasty in aseptic necrosis of femoral head. Travmatologiya iortopediya Rossii. 2009; 3(53): 116-118. (In Russ.)