A Systematic Review Of The Clinical Efficacy And Safety Of Hip Arthroscopic Assisted Core Decompression In The Treatment Of Avascular Necrosis Of The Femoral Head

Background:In recent years,hip arthroscopy has been widely used as a minnimally invasive treatment in femoral head necrosis,but it has not systematically evaluated its efficacy and safety.Objective:To evaluate the clinical efficacy and safety of arthroplasty in the treatment of avascular necrosis of the femoral head(AVNFH).Methods:Computer searches of Embase,The Cochrane Library,PubMed,CNKI,SinoMed Chinese Biomedical Document Service System,Weip Chinese Periodical Database,and Wanfang Database during 1966-2018.About the clinical studies of arthroscopic assisted core decompression was used to treat avascular necrosis of the femoral head.The main search terms “avascular necrosis of the femoral head,Osseoscopy,core Decompression,Arthroscopy,femoral head ischemic necrosis,femoral head aseptic necrosis,endoscopy”.Search the ralevant literatures,further obtain target documents and analyze the quality of the literature,and extract the data.The collected data was used for meta-analysis by using RevMan 5.3 software provided by Cochrane.The indicators were observed:clinical efficacy,Harris score,imaging change effect,operation time,postoperative complications,postoperative THA.Results:1.Inclusion of basic information in the literature: Final inclusion of 7 articles,4in English and 3 in Chinese.A total of 589 patients were enrolled in this study.A total of 801 hips were involved.Hip arthroscopy combined with core decompression(ACD)group included 378 patients with hip and core decompression group(CD)with 423 hips.2.Clinical efficiency: Compared with the CD group,the ACD group had significantly better postoperative recovery(OR = 2.16,95% CI(1.37,3.42),P =0.0010).Harris score: Compared with CD group,the Harris score was significantly improved after operation in ACD group(WMD=6.22,95%CI(3.96,8.49),P<0.00001),Harris sensitivity and subgroup analysis(WMD=6.76,95% CI(5.69,7.38),P<0.00001).4.Imaging changes: Compared with the ACD group,the CD group had a higher rate of femoral head collapse.(OR=0.41,95% CI(0.24,0.68),P=0.0007).5.Operative time: Compared with the CD group,the ACD group had a longer operation time.(WMD = 27.86,95% CI(20.02,35.70),P <0.00001).6.Postoperative complications: Compared with the CD group,the incidence of postoperative complications was higher in the ACD group.(OR=11.76,95% CI(2.14,64.48),P=0.005).7.Postoperative THA: Compared with ACD group,the incidence of THA after CD was higher.(OR=0.40,95% CI(0.20,0.80),P=0.0100).Conclusious:This study suggests that the arthroscopic combined with core decompression and core decompression in the treatment of avascular necrosis of the femoral head have a certain effect;according to the analysis of the evaluation indicators showed statistical differences.It shows that the combined use of arthroscopy can improve the efficacy,significantly improve joint function,delay or prevent the process of femoral head necrosis.Because arthroscopic surgery is complicated and difficult to operate,the rate of postoperative complications is higher and the duration of surgery is longer than core decompression.Overall,hip arthroscopic core decompression is safe and effective in the treatment of avascular necrosis of the femoral head,but it is limited by the quality of the study and the sample size.The above conclusion still needs to be further rigorous and has a larger sample size in the clinical control study.and support.