Navin Kumar Yadav
BRD Medical College Gorakhpur, IndiaPresentation Title:
TFL muscle pedicle iliac bone graft with L-arginine therapy for the treatment of pre-arthritic stages of avascular necrosis of femoral head
Abstract
Osteonecrosis of the femoral head is defined as necrosis of the bone tissue due to some form of vascular insult, subsequently leading to the collapse and secondary osteoarthritis. This disease is widely known to affect middle-aged populations; however, in India, even younger people are commonly affected. The disease has debilitating effect on the activities of daily living, the productivity of individuals, and has financial consequences.
This study comprised 40 patients with femoral head osteonecrosis, with an average age of 28.4 ± 3.6 years (18-50 years). The cases were classified using the Ficat and Arlet staging system, with seven cases (17.5%) in stage II and 33 cases (82.5%) in stage III. Patients were treated by decompression of the affected femoral head by multiple drillings and a 2.5 × 2.5 mm window created at the superolateral part of the head-neck junction. The window was filled by a tensor fascia lata (TFL) muscle pedicle-based iliac bone graft, followed by 16 to 20 weeks of protected weight bearing and L-arginine therapy (2 grams orally daily). The outcomes were assessed clinically by Harris hip score (HHS) and radiologically by resolution of the lesion. Partial and full weight bearing was allowed only after significant radiological improvement.
Among the cohort of 40 patients, the HHS indicated excellent (90-100) outcomes in 14 cases (35%), good (80-89) outcomes in 19 cases (47.5%), fair (70-79) outcomes in six cases (15%), and poor (<70) outcomes in one case (2.5%), at the time of the final follow-up. The mean follow-up period was 6.3 ± 3.7 years.
TFL muscle pedicle iliac bone graft along with protected weight bearing and L-arginine therapy should be given a chance to preserve the native femoral head and show excellent clinical and radiological outcomes, provided there are no arthritic changes. It reduces symptoms and improves functional outcomes.
Biography
Navin Kumar Yadav has completed his post graduation at the age of 30 years from DDU Gorakhpur University, India. He is working as Orthopaedics doctor at BRD Medical College Gorakhpur, India. He has published various research papers in national and international journals.
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