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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 7, 852-857.
doi: 10.1302/0301-620X.90B7.20125  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Elevated intraosseous pressure in the intertrochanteric region is associated with poorer results in osteonecrosis of the femoral head treated by multiple drilling

M. S. Lee, MD, PhD, Orthopaedic Surgeon1; P.-H. Hsieh, MD, Orthopaedic Surgeon1; Y.-H. Chang, MD, Orthopaedic Surgeon1; Y.-S. Chan, MD, Orthopaedic Surgeon1; S. Agrawal, MD, Clinical Fellow1; and S. W. N. Ueng, MD, Orthopaedic Surgeon1

1 Department of Orthopaedics Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan 333, Taoyuan, Taiwan.

Correspondence should be sent to Dr M. S. Lee; e-mail: bone{at}doctor.com

Multiple drilling is reported to be an effective treatment for osteonecrosis of the head of femur, but its effect on intra-osseous pressure has not been described. We undertook multiple drilling and recorded the intra-osseous pressure in 75 osteonecrotic hips in 60 patients with a mean age of 42 years (19 to 67). At a mean follow-up of 37.1 months (24 to 60), 42 hips (56%) had a clinically successful outcome. The procedure was effective in reducing the mean intra-osseous pressure from 57 mmHg (SD 22) to 16 mmHg (SD 9). Hips with a successful outcome had a mean pressure of 26 mmHg (SD 19). It was less effective in preventing progression of osteonecrosis in hips with considerable involvement and in those with a high intra-osseous pressure in the intertrochanteric region (mean 45 mmHg (SD 25)). This study is not able to answer whether a return of the intra-osseous pressure to normal levels is required for satisfactory healing.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General