Results of Multiple Drilling Compared with Those of Conventional Methods of Core Decompression

TLDR

The authors investigated whether a simpler multiple‑drilling procedure could achieve the therapeutic effects of core decompression for osteonecrosis of the femoral head. They retrospectively reviewed 136 patients (163 hips) who underwent multiple drilling with 9/64‑inch Steinmann pins, followed for a mean of 87 months, defining failure as the need for additional surgery or a Harris hip score <75. At a minimum 5‑year follow‑up, 79 % of Stage I and 77 % of Stage II hips avoided additional surgery, all small lesions and 84 % of medium lesions succeeded, while Stage III hips fared worse, large lesions performed poorly, one subtrochanteric fracture occurred, and overall outcomes were comparable to other core‑decompression techniques with few complications.

Abstract

We performed multiple drilling as a femoral head-preserving procedure for osteonecrosis of the femoral head thinking the therapeutic effects of core decompression could be achieved by this simpler procedure than core decompression. We retrospectively reviewed 136 patients (163 hips) who had multiple drilling using 9/64-inch Steinmann pins for treatment of nontraumatic osteonecrosis of the femoral head. The mean followup for patients who did not require additional surgery (113 hips) was 87 months (range, 60-134 months). We defined failure as the need for additional surgery or a Harris hip score less than 75. After a minimum 5-year followup, 79% (31/39) of patients with Stage I disease and 77% (62/81) of patients with Stage II disease had no additional surgery. All (15/15) small lesions (<25% involvement) and 84% (37/44) of medium-sized lesions (25-50% involvement) were considered successful. Survival rates of patients with Ficat Stages I or II lesions were greater than survival rates for patients with Stage III lesions. Hips with a large necrotic area had poor results. We had one instance of subtrochanteric fracture through drill entry holes. Multiple drilling is straightforward with few complications and produces results comparable to results of other core decompression techniques.