Effectiveness of platelet-rich plasma as an adjunct to core decompression to treatment outcomes and femoral head preservation in avascular necrosis of the hip: A meta-analysis of randomized controlled trials

Background@#Avascular necrosis (AVN) of the femoral head results from intraosseous pathology causing functional impairment. Early diagnosis allows conservative treatment like core decompression, delaying total hip arthroplasty.@*Objective@#This meta-analysis aims to summarize platelet-rich plasma's (PRP) impact as an adjunct to core decompression (CD) on treatment outcomes and femoral head preservation in hip AVN. @*Methods@#The study conducted a comprehensive literature search using PubMed, Cochrane Library, Science Direct, Google Scholar and Med Line, including randomized controlled trials (RCTs) and previous meta-analyses from various databases. Using a random effects model, it compared PRP+CD with bone grafting to CD with bone grafting alone in AVN patients, evaluating function, pain scores, disease progression and the need for hip surgery.@*Results@#The meta-analysis examined 1041 records and included three studies. The primary outcomes were function and pain scores using Harris Hip Scoring (HHS) and Visual Analog Scale (VAS). Postoperative HHS scores at final follow-up favored the PRP+CD group significantly over CD alone. Postoperative VAS scores showed a trend towards higher scores in the CD alone group. The PRP+CD group demonstrated higher survival from disease progression compared to CD alone. Overall, the study suggests that PRP+CD led to better functional outcomes and disease progression outcomes than CD alone in AVN of the hip.@*Conclusion@#The PRP+CD treatment group showed significant benefits in AVN patients compared to CD alone, including higher HHS scores, improved disease progression survival and reduced need for hip surgery. Although PRP+CD resulted in decreased VAS scores, the difference was not statistically significant.

Necrosis avascular: complicación en un paciente joven / Avascular Necrosis: Complication in a Young Patient

Resumen: La presentación de una fractura de fémur proximal es totalmente diferente en pacientes jóvenes que en pacientes adultos. A diferencia de la fractura cerrada de fémur proximal, la incidencia de fracturas expuestas se encuentra en la población joven de entre 15 y 30 años de edad. Dentro de las complicaciones que podemos observar en estas fracturas se encuentra la osteonecrosis avascular (NAV) de la cabeza femoral, la cual se define como la interrupción del aporte sanguíneo a la cabeza femoral, ya sea por trauma, infección, alcoholismo o uso de esteroides, ocasionando necrosis ósea, colapso articular y osteoartrosis. El tratamiento dependerá de la presentación del caso, la edad del paciente y el tiempo en hacer el diagnostico. Se presenta el caso clínico de un paciente de 16 años de edad el cual ingresa al servicio de urgencias con diagnóstico de herida por arma de fuego a nivel de cadera izquierda. Se realiza lavado quirúrgico y reducción cerrada más fijación interna con clavo centro medular. Se da un seguimiento clínico y radiográfico por 3 años observando la evolución de la fractura y la subsecuente necrosis avascular que presenta el paciente.

Abstract: The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infection, alcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented.

Management Of Asthi-majjagata Vata W.s.r. To Avascular Necrosis (avn) Of Femoral Head Stage 3 By Panchakarma - A Case Study

Avascular necrosis (AVN), also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis, is a condition that occurs when there is loss of blood supply to the bone, an interruption to the blood supply causes bone to die. If not stopped this process eventually cause the bone to collapse. It is the most challenging condition of the present era in orthopedics. In Ayurveda it can be co-related with the Asthi Majja Gata Vata due to similar sign and symptoms of Avascular necrosis of neck of femur. Aim and objectives: To assess the efficacy of Manjisthadi Kshara Basti, Rooksha Choorna Pinda Swedana, Pizhichil and Shastikashali Pinda Swedana in the management of AVN. Objective was to stop the further deterioration of the hip joint and to reduce the chances of surgical intervention in managing AVN. Materials and methods: A diagnosed and non operated case of Avascular necrosis of stage 3 with complaints of pain of bilateral hip joint, restricted movements and limping gait approached the out-patient division of the hospital and was managed by Rooksha Choorna Pinda Swedana, Manjisthadi Kshara Basti, Pizhichil and Shastikashali Pinda Swedana. Observation and Result: Significant improvement was noticed after the treatment. Pain was reduced significantly with improvement in range of movement. Patient was able to walk and climb stairs after the treatment without pain and stiffness. There was reduction in VAS scale, marked improvement was noticed in Harris Hip Score.

Analysis of factors related to prognosis of femoral neck fracture / 中华创伤骨科杂志

Objective To find out factors related to avascular necrosis (AVN) of femoral head through a retrospective study of patients with femoral neck fractures treated with cannulated screws.Methods Two hundred and thirty cases of femoral neck fracture whn had been treated with cannulated screws in our department from August 1994 to October 2003 were analyzed statistically.Six factors of patient,age,gender,fracture type (Garden clas- sification),reduction method (close or open),the quality of reduction (Garden Index) and time interval from injury to surgery were analyzed statistically with rank sum test and logistic multiple regression.Results Factors that might have an impact on avascular necrosis of femoral head were ranked in the following likelihood sequence: fracture type,quality of reduction,reduction method,time interval from injury to surgery and age.Gender was found to have little impact on the prognosis of femoral neck fracture (P＞0.05).Conclusions Fracture displacement is the most critical factor that influences the prognosis.Anatomical reduction (close or open) must be achieved to re- duce the risk of AVN.Timing of surgery shows its importance.High age will not lead to an increased incidence of AVN.