ABSTRACT
BACKGROUND: The aim of this paper is to present the operative technique and results of core decompression and clearing of a necrotic zone in the femoral head followed by filling the defect with impacted autologous or synthetic bone grafts. This procedure allows for mechanical prevention of further collapse of the femoral head and loss of its spherical shape. It also creates conditions for the incorporation of the biological graft or synthetic bone. MATERIALS AND METHODS: A series of 63 patients (72 hips) were treated for aseptic osteonecrosis of the femoral head between 1996 and 2009. This group comprised 42 men and 21 women aged 19 to 60 years (average age: 35 years). Radiographic staging of necrosis was based on the ARCO (Association Research Circulation Osseous) classification. All patients were treated with core decompression followed by filling the bone defect with autologous or synthetic (Wright ProDense) bone grafts. RESULTS: Average follow-up was 5 years (from 1 to 12 years). After one year of follow-up, pain relief with preservation of a spherical femoral head was obtained in 45 hips (63%). Sixteen hips (22%) had significant limitation of the range of motion that, however, did not exceed preoperative values, with no significant pain during walking, and loss of the spherical shape of the femoral head on radiographs. CONCLUSIONS: Filling the defect with morsellized or synthetic bone grafts followed by graft impaction creates mechanical and biological conditions for graft incorporation. Where collapse has not occurred during the first six post-operative months, a good and lasting result can be expected.
Subject(s)
Bone Transplantation , Decompression, Surgical/methods , Femur Head Necrosis/surgery , Adult , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Contemporary medicine, together with the increase in invasiveness into the patient's body, exerts mounting pressure on state institutions and medical chambers aiming at the development of suitable regulations protecting patients against excessive interference with their bodies and psyche, and also allowing for their full autonomy. A gradual shift in the doctors' behaviour from a paternalistic approach towards partnership becomes more apparent. Its purpose is to take shared decisions concerning diagnostic methods and treatment. This process is best noticed when it comes to the issue of taking medical measures after obtaining patient's conscious agreement. The term 'conscious agreement' emerged in the legal terminology fairly late, in 1957, during the lawsuit Salgo vs. Leland Stanford Junior University Board of Trustees. Much later it found its place in the legal regulations concerning everyday medical routines. The fundamental factor of the patient's autonomy and simultaneously a remedy to the risk of patients acting against their own good is the process of obtaining the sick person's conscious agreement prior to anticipated medical measures, both therapeutic and diagnostic. The patient's informed conscious agreement to diagnostic process and treatment is not only the crucial prerequisite of doctor's lawful behaviour but also a significant evaluation criterion with regard to doctor's deeds and intentions. We requested doctors to share their opinion, in the form of an anonymous feedback form, on the issue of obtaining from patients their conscious agreement to diagnostic and therapeutic measures. The survey was carried out among 231 physicians of different specialisations from the Lublin Province and Podkarpackie Province employed both in hospitals, outpatient clinics and in health centres for basic medical care. Almost all the respondents declared the knowledgw of the regulations on the protection of patients' rights; however, only half of the surveyed persons expressed the opinion that the regulations concerning patient's rights refer also to diagnostic examination. Doctors clearly differed with regard to the meaning of the notion of 'giving conscious consent by the patient' and tended to associate such a patient's declaration only with invasive procedures. The survey results allowed us to outline the level of knowledge and the degree of compliance with patient's rights related to the necessity of obtaining conscious consent to medical treatment.
