Arthroscopic manifestations of necrosis of the femoral head
- VernacularTitle:股骨头坏死的关节镜下表现及分析
- Author:
Lei ZHANG
;
Jinsong LIU
;
Jin SUN
- Publication Type:Journal Article
- Keywords:
Hip joint;
Arthroscopy;
Necrosis of the femoral head
- From:Chinese Journal of Minimally Invasive Surgery
2005;0(12):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe arthroscopic manifestations of necrosis of the femoral head and to evaluate the results. Methods Arthroscopic operations were performed in 38 hips in 27 patients (19 male and 8 female) with necrosis of the femoral head. There were 8 hips of Ficat stage Ⅰ, 21 hips of stage Ⅱ, 7 hips of stage Ⅲ, and 2 hips of stage Ⅳ, respectively. The arthroscopic operation included an assessment of the appearance and texture of the femoral head, the acetabulum, and the synovium, debridement of the joint, and femoral head decompression by drilling small holes. Results Arthroscopically, the Ficat stage I hips were considered to have a intact articular surface, with normal appearance and instrument compression, displaying a hyperaemia and swelling of the synovial tissue. The stage Ⅱ hips presented a major portion of the normal articular surface, chondromalacia of the weight bearing portion of the femoral head, fissures on the articular surface, and sinking with instrument compression. A cleavage plane was formed between the fractured and collapsed necrotic subchondral bone, but the cartilage still communicated with the calcificated layer. The surface of necrotic bone was sclerosesed and rough like sandstones. Hyperplasia of the synovial tissue was seen. The stage Ⅲ hips manifested a massive disassociation of the articular surface from the underlying subchondral bone and the delamination of the femoral head. The subchondral bone was collapsed and disintegrated, with ineffective repaired granulation tissue in it. The stage Ⅳ hips displayed narrowing of the joint space, extensive chondral lesions of the femoral head, collapse of necrotic subchondral bone exposed, and degenerative changes on the acetabulum side, all of which were consistent with the end-stage of osteoarthritis. Conclusions Articular cartilage impairment plays an important role in the process of the necrosis of the femoral head. The value of hip arthroscopic examinations lies in accurate evaluation of the extent of the chondral impairment and important reference for the choice of procedures.
