Descompressão isolada da cabeça femoral versus tratamento conservador para osteonecrose não traumática: uma revisão sistemática com metanálise.

Abstract

Introduction: Femoral head necrosis (FHN) is a condition that can lead to progressive destruction of the hip joint. It is common between the third and fifth decades of life, being the diagnosis responsible for 5 to 18% of the total hip arthroplasties (THA). Among joint preservation treatments, the role of central decompression (CD) is still debated. Objective: To compare the effectiveness of central decompression (CD) and conservative treatment (CT) to save femoral heads in patients with avascular necrosis of the femoral head. Results: Four clinical trials and two cohorts involving 316 hips with a mean follow-up of 22 to 48 months were included in this review. Our results suggested that patients undergoing CD were less likely to undergo total hip replacement arthroplasty [OR = 0,42 (IC de 95%, 0,20–0,85); I 2 = 0,00%; p = 0,74]. In the analysis of the radiographic progression rate stratified by the stage of FHN, the CD group had a significantly lower failure rate than the TC group at stages 0/I [OR = 0,32 (IC de 95%, 0,11–0,96); I 2 = 25,41%; p = 0,26], but not in stage 2, [OR = 0,68 (IC de 95%, 0,14–3,34); I 2 = 71,84%; p < 0,01], neither in stage 3, [OR = 1,21 (IC de 95%, 0,11–12,85; I 2 = 67,37%; p = 0,05)]. Conclusions: Performing the CD is effective in preventing the progression to femoral collapse in the early stages of FHN in a short-term follow-up and reduces the chance of a total hip arthroplasty. However, the short-term follow-up and the small sample size of the current meta-analysis provide only limited quality of evidence. Randomized controlled trials with a larger sample size and a long-term follow-up are needed to provide further insights into the optimal treatment of FHN.