TREATMENT

THE NIJMEGEN PROTOCOL FOR TREATMENT OF OSTEONECROSIS.

J.W.M. Gardeniers, W. Rijnen, B. Westrek, P. Buma, B.W. Schreurs,
K. Yamaso, T.J. Slooff
University Hospital Nijmegen, the Netherlands.

Background: The clinical results of treatment of osteonecrosis of advanced stages with moderate of sever collapse are poor. Despite of the young age of the patients, prosthetic replacement is often required. Recently, we can detect the preradiological osteonecrotic lesion of the femoral head by MRI. A band-like pattern on the MRI is a specific finding in preradiological osteonecrosis. Histologically, the band-like low signal is a demonstration the granulation fibrous tissue of the repairing reaction in the ischemic femoral head. Prediction of collapse is possible by measuring the extent of the necrotic lesion shown as the area of normal signal surrounded by a low signal area^{1) 2)} Furthermore; the location of necrotic lesion is an important factor for the symptomatic onset and the radiologically visible collapse. We can start the treatment of early stages osteonecrosis which is visible as a large necrotic lesion on MRI before sever collapse. Biological procedures to try to prevent the necrotic heads to collapse are fibular grafting³⁾ or structural bone graftings⁴⁾. However, the collapse was not prevented by these procedure and the clinical results are not satisfactory. Recollapse of the femoral head also occurred in the mild collapsed cases. Sugioka's Osteotomy⁵⁾ is a valuable procedure, but in western countries not a procedure of first choice. The procedure is difficult and the results in the west are not reported favorable. Enough initial stability of bone graft and early bone remodeling with a new trabecular structure is necessary to prevent the collapse and maintain the normal joint function.

In the last ten years the Institute of Orthopaedics has developed a special technique using impacted morsellized bone allograft to repair the acetabular and femoral bone deficiencies in primary and revision total hip arthroplasties^{6),7),8).9),10),1l).12),13),14)} In animal experiments was shown that the initial stability of the graft was large enough to allow load bearing and that the graft rapidly revitalized into a new trabecular structure^{6),8),9),10),11)}

Materials and Methods: All patients with Impacted Grafting and Sugioka's Osteotomy were reviewed. According to the results a protocol for the treatment was developed. All treatment modalities, e.g. Conservative treatment, Impaction Grafting, Sugioka's Osteotomy and Total Hip Replacement were included.

Treatment Protocol ONFH in Nijmegen

Literature

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