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Comparative Study of Core Decompression with Autologous Iliac Crest Bone Graft Versus Bone Marrow Infiltration in Osteonecrosis of Femoral Head

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Original Article | Journal of Clinical Orthopaedics | Vol 10 | Issue 2 | July-December 2025 | page: 85-89 | Manish Kumar Yadav, O.P Lakhwani, Rajan Kumar Kaushal, Sathyendra KG, Venkatesh Kumar S, Sanjay Singh Rawat

DOI: https://doi.org/10.13107/jcorth.2025.v10.i02.786

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 26 Aug 2025, Review Date: 12 Sep 2025, Accepted Date: 27 Oct 2025 & Published Date: 10 Dec 2025

Author: Manish Kumar Yadav [1], O.P Lakhwani [1], Rajan Kumar Kaushal [1], Sathyendra KG [1], Venkatesh Kumar S [2], Sanjay Singh Rawat [2]

[1] Department of Orthopaedics , ESI-PGIMSR,Hospital Basaidarapur, New Delhi-110015
[2] Department of Orthopaedics, Dhanalakshmi Srinivasan Medical College And Hospital, Siruvachur, Perambalur – 621 113. Tamilnadu, India

Address of Correspondence

Dr. Dr. Sathyendra KG,
Senior Resident, Department of Orthopaedics , ESI-PGIMSR,Hospital Basaidarapur, New Delhi-110015
E-mail: drsathyendrakg@gmail.com

Abstract

Background: We intend to determine the difference in outcome of core decompression with autologous iliac crest bone graft versus bone marrow infiltration in avascular necrosis (AVN) of femoral head.
Materials and Methods: Stage II, III of Ficat and Arlet of AVN of femoral head evaluated clinically and radiologically before getting included into this study. A minimum of 20 cases were studied after clearance from the Ethics committee.
Results: In our study, the mean HHS were statistically significant differences between the groups at 3 months and 6 months (P <0.05). At 3 months, the mean Visual Analog Scale (VAS) was 5.7 in Group A and 4.3 in Group B. At the end of the study (6 months), the mean VAS was 4.9 in group A and 2.7 in Group B. However, there were statistically significant differences between the groups at 3 months and 6 months (P < 0.05). Stage III X-ray finding was most common in Group a (63.6%) at pre-operative, and Stage II was most common in Group B (63.6%) at pre-operative. A similar finding was found at 6 months post-operative. Stage III magnetic resonance imaging (MRI) finding was most common in Group a (63.6%) at pre-operative and Stage II was most common in Group B (63.6%) at pre-operative. There was no significant difference (P > 0.05) in MRI and X-ray findings at pre-operative and 6 months between the groups.
Conclusion: We conclude that core decompression with bone marrow infiltration is better to iliac crest bone graft because of better HHS and VAS at 6 months in Stage II, III of Ficat and Arlet of AVN of femoral head.
Keywords: Osteonecrosis of femoral head, Core decompression, Autologous iliac crest bone graft, Bone marrow infiltration, Harris Hip Score

References

1. Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: Pathophysiology and current concepts of treatment. EFORT Open Rev 2019;4:85-97.
2. Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecrosis of the femoral head. World J Orthop 2015;6:590-601.
3. Musso ES, Mitchell SN, Schink-Ascani M, Bassett CA. Results of conservative management of osteonecrosis of the femoral head. A retrospective review. Clin Orthop Relat Res 1986;207:209-15.
4. Atilla B, Bakırcıoğlu S, Shope AJ, Parvızı J. Joint-preserving procedures for osteonecrosis of the femoral head. EFORT Open Rev 2020;4:647-58.
5. Babhulkar S. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting. Indian J Orthop 2009;43:27-35.
6. Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: Ten years later. J Bone Joint Surg Am 2006;88:1117-32.
7. Wu ZY, Sun Q, Liu M, Grottkau BE, He ZX, Zou Q, et al. Correlation between the efficacy of stem cell therapy for osteonecrosis of the femoral head and cell viability. BMC Musculoskelet Disord 2020;21:55.
8. Kangari P, Talaei-Khozani T, Razeghian-Jahromi I, Razmkhah M. Mesenchymal stem cells: Amazing remedies for bone and cartilage defects. Stem Cell Res Ther 2020;11:492.
9. Sen RK, Tripathy SK, Aggarwal S, Marwaha N, Sharma RR, Khandelwal N. Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: A randomized control study. J Arthroplasty 2012;27:679-86.
10. Shukla BB, Malviya D, Kumar S, Misra S, Kumar S, Parashar S. Comparative evaluation of Visual Analog Scale and pupillary diameter for post-operative pain: An observational study. Indian J Anaesth 2023;67:S93-8.
11. Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol 2006;186:1761-70.
12. Stroie OM, Vu VH. Osteonecrosis imaging. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK604199 Accessed 26 November 2025.
13. Karimi M, Moharrami A, Vahedian Aedakani M, Mirghaderi SP, Ghadimi E, Mortazavi SJ. Predictors of core decompression success in patients with femoral head avascular necrosis. Arch Bone Jt Surg 2023;11:517-23.
14. Shiravani Brojeni S, Hesarikia H, Rahimnia A, Emami Meybodi MK, Rahimnia A. Treatment of femoral head osteonecrosis (stages 2b, 3 ficat) through open direct core decompression by allograft impaction and light bulb technique. Arch Bone Jt Surg 2020;8:613-9.

How to Cite this Article: Yadav MK, Lakhwani OP, Kaushal RK, Sathyendra KG, Venkatesh Kumar S, Sanjay Singh Rawat. Comparative Study of Core Decompression with Autologous Iliac Crest Bone Graft Versus Bone Marrow Infiltration in Osteonecrosis of Femoral Head. Journal of Clinical Orthopaedics. July-December 2025;10(2):85-89.

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Comparative study of different approaches of Total Hip Arthroplasty based on inclination angle of acetabular cup and Post operative rehabilitation

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 32-37 | Mohd Danish, Akhilesh Yadav, Ashutosh Karn

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.710

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 11 Jan 2025, Review Date: 08 Mar 2025, Accepted Date: 10 Apr 2025 & Published Date: 30 Jun 2025

Author: Mohd Danish [1], Akhilesh Yadav [1], Ashutosh Karn [2]

[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India,
[2] Department of Orthopaedics, Max Superspeciality Hospital, Saket, Delhi, India

Address of Correspondence

Dr. Mohd Danish,
Department of Othopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com

Abstract

Introduction: Total hip arthroplasty (THA) is considered to be one of the most successful orthopaedic interventions of its generation. Joint replacement (arthroplasty) as a surgical option for end stage arthritis is well established now and millions of patients across the world have benefited. India is a country of 1.4 billion people with significant knee and hip arthritis population. According to Frost and Sullivan research, 70,000 joint replacement surgeries were performed in India in the year 2011. The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
Aims of Study: To compare post-operative outcome as implant positioning in terms of abduction angle of the cup & rehabilitation based on Harris Hip Score at 2 months and 4 months respectively in different approaches of approach of total hip replacement.
Materials and Methods: This study was conducted in the department of Orthopaedics at Max Super specialty hospital, Vaishali, Ghaziabad, UP after receiving clearance from the Ethical Committee of the institution. It was a randomized case control study. Two different groups of 32 patients each were evaluated and inclination of acetabular cup was calculated on plain radiograph, subsequently the rehabilitation was also evaluated on basis of Harris Hip score in these patients.
Results: In the present study, it was observed that mean postoperative abduction angle in Group A 47.82 ±6.87 and Group B was 51.19 ±7.21 degree respectively. The mean postoperative abduction angle in Group A was less compared to Group B with statistical significance. (P<0.05) In the present study, it was observed that intergroup comparison of mean Harris hip score post-operative at discharge, at 2 months & 4 months in Group A and Group B showed no statistical significance. (P>0.05) The intragroup comparison of mean Harris hip score post-operative at discharge, 2 months and 4 months in Group A and Group B showed statistical significance. (P<0.05)
Conclusion: Present study revealed a significant statistical difference on intragroup comparison of inclination angle and rehabilitation based on Harris Hip Score in both the groups.
Keywords: Arthroplasty, Harris Hip Score, Angle of Inclination

References

1. Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res 1970;72:7-21.
2. Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015;97:1386-97.
3. ”Inpatient Surgery”. FastStats. National Center for Health Statistics. Centers for Disease Control and\ Prevention. 2010.
4. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005;87:1487-97.
5. Singh JA. Epidemiology of knee and hip arthroplasty: A systematic review. Open Orthop J 2011;5:80-5.
6. Morrey BF. A historical perspective of hip arthroplasty and reconstructive surgery. In: Cashman J, Goyal N, Parvizi J, editors. The Hip: Preservation, Replacement and Revision. Brooklandville, MD: Data Trace Publishing Company; 2015. p. 1.1-1.19.
7. Dislocations after total hip – replacement arthroplasties G E Lewinnek, J L Lewis, R Tarr, C L Compere, J R Zimmerman 1978 Mar;60(2):217-20 , PMID: 641088.
8. DiGioia A III, Plakseychuk AY, Levison TJ, Jaramaz B. Mini-incision technique for total hip arthroplasty with navigation. J Arthroplasty 2003;18:123–128
9. Chimento G, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP. Minimally invasive total hip arthroplasty. A prospective randomized study. J Arthroplasty 2005; 20:139–144.
10. Sculco TP, Jordan LC, Walter WL. Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience. Orthop Clin North Am 2004; 35:137–142.
11. Nakamura S, Matsuda K, Arai N, Wakimoto N, Matsushita T. Mini-incision posterior approach for total hip arthroplasty. Int Orthop 2004; 28:214–217.
12. Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O_Brien S, Beverland D. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. J Bone Jt Surg (Am) 2005; 87:701–710.
13. Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Jt Surg (Am) 2004; 86:1353–1358.
14. Ozaki Y, Baba T, Homma Y, Ochi H, Watari T, Banno S, Matsumoto M, Kaneko K. Posterior versus direct anterior approach in total hip arthroplasty: difference in patient-reported outcomes measured with the Forgotten Joint Score-12. SICOT-2018; J, 4, 54.
15. Laffosse JM, Chiron P, Molinier F, Bensafi H, Puget J. Prospective and comparative study of the anterolateral mini-invasive approach versus minimally invasive posterior approach for primary total hip replacement. Early results. International orthopaedics. 2007 Oct;31(5):597-603.

How to Cite this article: Danish M, Yadav A, Karn A. Comparative study of different approaches of Total Hip Arthroplasty based on inclination angle of acetabular cup and Post operative rehabilitation. Journal of Clinical Orthopaedics January-June 2025;10(1):32-37.

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Comparing the Efficiency of the Femoral Neck System and the Cannulated Compression Screw in Treating Femoral Neck Fractures in Patients Who Are Young and Middle-aged Indian Population

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 16-20 | Arvind Vatkar, Sachin Kale, Gaurav Kanade, Ashok Godke, Joydeep K. Dey, Rahul Godke, Nrupam Mehta, Sonali Das

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.584

Authors: Arvind Vatkar [1], Sachin Kale [1], Gaurav Kanade [2], Ashok Godke [3], Joydeep K. Dey [4], Rahul Godke [4], Nrupam Mehta [3], Sonali Das [4]

[1] Department of Orthopaedics, Apollo Hospital, Belapur, Navi Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, MGM Hospital, Kamothe, Navi Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Dr. D. Y. Patil Hospital, Navi Mumbai, Maharashtra, India.
[4] Department of Orthopaedic, Matoshree Hospital, Panvel, Navi Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Arvind Vatkar,
Consultant Spine Surgeon, Department of Orthopaedics, Apollo Hospital, Belapur, Navi Mumbai, Maharashtra, India.
E-mail: vatkararvind@gmail.com

Abstract

Background: There are no long-term studies regarding the clinical effectiveness of a novel fixation technique (femoral neck system [FNS]) for femoral neck fractures. The primary aim of this study was to compare the effectiveness of two internal fixation techniques (FNS and cannulated compression screw [CCS]) for treating femoral neck fractures in individuals between the ages of 20 and 40 years.
Materials and Methods: Data of patients who underwent internal fixation surgery for femoral neck fractures in our hospital between January 2018 and January 2020 with CCS and between January 2020 and January 2022 with FNS were retrospectively evaluated. The groups of CCS and FNS were separated based on the various internal fixation techniques. Demographics about all patients, including sex, age, body mass index, and fracture type were recorded. Pre-operative and 1-year post-operative follow-up of patients was to assess femoral neck shortenings and the Harris Hip score was used to evaluate joint function. Post-operative complications such as femoral head necrosis, non-union, and femoral neck shortening were noted.
Results: 30 patients each of CCS and FNS system fixation were enrolled in the study. The male-to-female ratio was 21:9 and 18:12 for CCS and FNS, respectively. The average age of both groups was around 30 years. Compared to patients treated with CC screws, patients who had FNS treatment required less time to recuperate and resume normal activities. The HSS score improvement at 2 weeks and 12 weeks was significantly better in the FNS system than CCS fixation. There was improvement in flexion, abduction, and external rotation range of motion in FNS compared to CCS. There was no statistically significant difference between the two groups in the incidence of femoral head necrosis or fracture non-union following surgery.
Conclusion: Patients treated with FNS for femoral neck fractures in the age range of 20–40 years can achieve better hip scores than CCS fixation and also have improved range of motion in flexion, abduction, and external rotation.
Keywords: Femoral neck system, cannulated cancellous screw, femoral neck fractures, harris hip score

References

1. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am 2008;90:2254-66.
2. Thorngren KG, Hommel A, Norrman PO, Thorngren J, Wingstrand H. Epidemiology of femoral neck fractures. Injury 2002;33 Suppl 3:C1-7.
3. Protzman RR, Burkhalter WE. Femoral-neck fractures in young adults. J Bone Joint Surg Am 1976;58:689-95.
4. Chandler HP, Reineck FT, Wixson RL, McCarthy JC. Total hip replacement in patients younger than thirty years old. A five-year follow-up study. J Bone Joint Surg Am 1981;63:1426-34.
5. Schaller F, Sidelnikov E, Theiler R, Egli A, Staehelin HB, Dick W, et al. Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone 2012;51:347-52.
6. Morri M, Chiari P, Forni C, Orlandi Magli A, Gazineo D, Franchini N, et al. What factors are associated with the recovery of autonomy after a hip fracture? A prospective, multicentric cohort study. Arch Phys Med Rehabil 2018;99:893-9.
7. Pashikanti L, Von Ah D. Impact of early mobilization protocol on the medical-surgical inpatient population: An integrated review of literature. Clin Nurse Spec 2012;26:87-94.
8. Mehraj M, Khurana S, Joshi UR, Jain A, Kumar B, Prakash BB, et al. Early results of internal fixation with femoral neck system in young patients with femoral neck fracture. Ortop Traumatol Rehabil 2022;24:305-9.
9. Khoo C, Haseeb A, Ajit Singh V. Cannulated screw fixation for femoral neck fractures: A 5-year Experience in a single institution. Malays Orthop J 2014;8:14-21.
10. Carneiro MB, Alves DP, Mercadante MT. Physical therapy in the postoperative of proximal femur fracture in elderly. Literature review. Acta Ortop Bras 2013;21:175-8.
11. Strini V, Piazzetta N, Gallo A, Schiavolin R. Barthel index: Creation and validation of two cut-offs using the BRASS Index. Acta Biomed 2020;91:19-26.
12. Zhang YZ, Lin Y, Li C, Yue XJ, Li GY, Wang B, et al. A Comparative analysis of femoral neck system and three cannulated screws fixation in the treatment of femoral neck fractures: A six-month follow-up. Orthop Surg 2022;14:686-93.
13. Yang J, Zhou X, Li L, Xu L, Zhu W, Xu W, et al. Comparison of femoral neck system and inverted triangle cannulated screws fixations in treatment of Pauwels typle femoral neck fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021;35:1111-8.
14. Yan C, Wang X, Xiang C, Jiang K, Li Y, Chen Q, et al. Comparison of effectiveness of femoral neck system and cannulate compression screw in treatment of femoral neck fracture in young and middle-aged patients. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2021;35:1286-92.

How to Cite this article: Vatkar A, Kale S, Kanade G, Godke A, Dey JK, Godke R, Mehta N, Das S. Comparing the Efficiency of the Femoral Neck System and the Cannulated Compression Screw in Treating Femoral Neck Fractures in Patients Who Are Young and Middle-aged Indian Population. Journal of Clinical Orthopaedics 2023;8(2):16-20.

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