Osseoscopy: Direct Visualization to Assist Core Decompression and Debridement of Necrotic Bone Defects
Open accessAbstract
Free vascularized fibular grafting after core decompression and debridement of necrotic lesions is an effective surgical treatment of avascular necrosis of the femoral head. A technical challenge encountered in performing this procedure is ensuring adequate debridement of necrotic parts while preserving healthy bone. A previously described method accomplishes this indirectly using radioactive contrast media and fluoroscopy, increasing the risk of radiation exposure. We propose a surgical technique using standard arthroscopic equipment to visualize inside the femoral head, facilitating precise and accurate debridement without additional radiation exposure.
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Intraoperative imaging techniques such as C-arm fluoroscopy or X-ray are important for localizing the greater trochanter, tracking and navigating the drilling and injection device to the femoral head, and positioning the trephine and scraping spoon while removing dead bone.
“Intraoperative imaging techniques such as C-arm fluoroscopy or X-ray have become important for the localization of the greater trochanter, tracking and navigation of the drilling and injection device to the femoral head, and positioning of the trephine and scraping spoon while removing the dead bones (Nolte et al. 2000; Geisert et al. 2017; Tian et al. 2021).”
From Towards 2D/3D Registration of the Preoperative MRI to Intraoperative Fluoroscopic Images for Visualisation of Bone Defects (2023) · cites this paper as Geisert et al. 2017
The Core Decompression section (page not provided) describes C-arm fluoroscopy guiding a pin toward the femoral-head lesion and live fluoroscopy guiding reaming. The Approach to Hip section describes an incision centered over the greater trochanter, but not imaging to localize it. The Osseoscopy section describes camera-guided curette debridement, not fluoroscopic positioning of a trephine or scraping spoon; the paper does not describe an injection device. (LLM, conf=0.88)
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Research works printed but not linked: 11
- Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985;67:3-9.
- Jergesen HE, Khan AS. The natural history of untreated asymptomatic hips in patients who have non-traumatic osteonecrosis. J Bone Joint Surg Am 1997;79:359-363.
- Urbaniak JR, Harvey EJ. Revascularization of the femoral head in osteonecrosis. J Am Acad Orthop Surg 1998;6:44-54.
- Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg Am 1999;81:200-209.
- Eward WC, Rineer CA, Urbaniak JR, Richard MJ, Ruch DS. The vascularized fibular graft in precollapse osteonecrosis: Is long-term hip preservation possible? Clin Orthop Relat Res 2012;470:2819-2826.
- Fang T, Zhang EW, Sailes FC, McGuire RA, Lineaweaver WC, Zhang F. Vascularized fibular grafts in patients with avascular necrosis of femoral head: A sys- tematic review and meta-analysis. Arch Orthop Trauma Surg 2013;133:1-10.
- Kim SY, Kim YG, Kim PT, Ihn JC, Cho BC, Koo KH. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am 2005;87:2012-2018.
- Marciniak D, Furey C, Shaffer JW. Osteonecrosis of the femoral head. A study of 101 hips treated with vascular- ized fibular grafting. J Bone Joint Surg Am 2005;87:742-747.
- Urbaniak JR, Coogan PG, Gunneson EB, Nunley JA. Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting. A long-term follow-up study of one hundred and three hips. J Bone Joint Surg Am 1995;77:681-694.
- Aldridge JM III, Berend KR, Gunneson EE, Urbaniak JR. Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head. Surgical technique. J Bone Joint Surg Am 2004;86:87-101 (suppl 1).
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Ku, P.-C., Martin-Gomez, A., Gao, C., Grupp, R., Mears, S. C., & Armand, M. (2023) · Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization · doi:10.1080/21681163.2022.2152375 · Cited by 8 · see citing works
“…X-ray have become important for the localisation of the greater trochanter, tracking and navigation of the drilling and injection device to the femoral head, and positioning of the trephine and scraping spoon while removing the dead bones (Nolte et al. 2000; Geisert et al. 2017; Tian et al. 2021).”
Background
- Authors
- Geisert, W. C., Perdue, A. M., & Ozer, K.
- Affiliations
- University of Michigan (US)
- Department of Orthopaedic Surgery University of Michigan Ann Arbor Michigan U.S.A.
- ORCID
- Perdue, Aaron M.
- Venue
- Arthroscopy Techniques
- Publisher
- Wiley
- Published
- 2017-05-15
- Volume
- 6
- Issue
- 3
- Pages
- e607-e612
- ISSN
- 2212-6287 (ISSN-L)
- PMC
- PMC5495213
- OpenAlex
- W2615120858
- Cited by
- 5
- References
- 0
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Arthroscopy Techniques (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone and Joint Diseases
- Health Sciences › Medicine › Surgery › Hip disorders and treatments
- Health Sciences › Medicine › Rheumatology › Bone Tumor Diagnosis and Treatments
- Keywords
- core decompression, debridement, osteonecrosis of the femoral head, avascular necrosis, free vascularized fibular graft, arthroscopic visualization, radiation avoidance, femoral head
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