P-ISSN: 2707-8345, E-ISSN: 2707-8353
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International Journal of Case Reports in Orthopaedics
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International Journal of Case Reports in Orthopaedics

2022, Vol. 4, Issue 2, Part B

Effect of drilling and bone substitute on revascularization of an avascular femoral head


Author(s): Dr. Jignesh Patel, Dr. Yash Mehta and Dr. Rishi Patel

Abstract: Introduction: Avascular Necrosis (AVN) is pathology in which femoral head undergoes degenerative changes due to reduced blood supply. Osteotomy is surgical procedure that involves cutting bone to reshape or realign your bones. It acts by multiple mechanisms. Newer mechanisms include increased blood flow, Osteoinduction due to new fracture (Osteotomy), Change of shear force into compression force. Novel concept for AVN treatment is blocking of femoral canal near lesser trochanter area by Osteotomy/Drilling and insertion of synthetic absorbable Bone substitute (hydroxyapatite cement). Thereby blocking the trabecular canal system at junction so Blood supply get diverted towards femoral head. Methods and Materials: Study was carried out in New Civil Hospital, Surat in September 2021. The prospective study comprised of 62 year old male having C/o Pain, limp while walking and restriction of Adduction and Internal rotation of Left Hip. Xray, MRI of both hip showed Left Avascular Necrosis Femoral Head (Ficat Arlet Grade 2B). Via Lateral incision of Hip, Drilling and Scooping done at level of Lesser Trochanter. Drilled site was inserted with 10-12 gm of synthetic absorbable Bone substitute (hydroxyapatite cement). Full weight bearing started after 1 week. All patients were followed up immediately, 3rd month, 6th month, 1 year. Follow up X-ray were taken to assess radiological outcome and Harris Hip score for functional outcome. Results: Xray at 3rd, 6th month, 1 year showed No further progression of Grade 2B AVN Femoral head. Improvement in Harris Hip Score with values 38, 67, 81, 89 at Immediate, 3rd, 6th month, 1 year postop respectively. Improvement in Left Hip range of motion. Conclusion: Drilling creates disturbance in trabecular canal system (Creating haematoma callus) so that proximal shaft femoral blood supply is cut off (partially) and that blood supply which was destined for the upper shaft is now directed more proximally Towards femoral head.

DOI: 10.22271/27078345.2022.v4.i2b.129

Pages: 89-93 | Views: 63 | Downloads: 21

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How to cite this article:
Dr. Jignesh Patel, Dr. Yash Mehta, Dr. Rishi Patel. Effect of drilling and bone substitute on revascularization of an avascular femoral head. Int J Case Rep Orthop 2022;4(2):89-93. DOI: 10.22271/27078345.2022.v4.i2b.129


International Journal of Case Reports in Orthopaedics
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