MEYER'S Procedure treatment for Avascular necrosis of femur head

we have done femoral head preserving surgery for AVN by meyers procedure & we hv got so encouraging results. that this procedure needs attention.

1. AVASCULAR NECROSIS OF THE HIP BY MAYER’S TECHNIQE By Dr. Ranveer Patel Orthopaedic Surgeon, Shreeji Orthopaedic Care

2. DEFINITION Avascular necrosis, also known as osteonecrosis or aseptic necrosis, is a disease of impaired osseous blood flow.

3. BLOOD SUPPLY OF FEMORAL HEAD

4. Etiology and Risk Factors

5. AVASCULAR NECROSIS OF THE HIP VERY COMMON CONDITION YOUNG PATIENTS BILATERAL INVOLVEMENT IMPENDING COLLAPSE AND FURTHER COMPLICATIONS MEDICAL TREATMENT UNSATISFACTORY

6. CAUSES OF PAIN INCREASED BONE MARROW PRESSURE SUBCHONDRAL FRACTURES

7. PLAIN X-RAY FILM Mottled trabecular pattern Sclerosis Fragmentation Subchondral cyst Subchondral fractures Collapse

8. TREATMENT OPTIONS MEDICAL TREATMENT: BIS-PHOSPHONATES NSAIDS STATINS RESULTS ARE INCONSISTENT BED REST ONCE ADVOCATED(NON WEIGHT BEARING) IS USELESS

9. SURGICAL OPTIONS CORE DECOMPRESSION CORE DECOMPRESSION WITH BONE GRAFTING MUSCLE PEDICLE AUGMENTATION SURFACE REPLACEMENT TOTAL HIP REPLACEMENT

10. OUR EXPERIENCE PRINCIPLES : HIP PRESERVATION DECOMPRESSION AUGMENTING VASCULARITY RELIEF OF SYMPTOMS DELAY THE COMPLCATIONS REPLACEMENT OPTIONS ARE VIABLE IN FUTURE IF NEEDED

11. CASE NO.1 PT. CAME WITH C/O PAIN IN BOTH HIP MORE TOWARDS RIGHT SIDE SINCE 1 MONTH ON 6 JUNE 2016 FOR WHICH HE WAS GIVEN SYMTOMATIC TREATMENT AND ADVICED FOR FOLLOW UP WITH MRI AND SURGERY PT. HAD NO H/O CORTICOSTEROID INGESTION OR ALCOHOL INGESTION… PT. IS RADIO-TECHNICIAN BY OCCUPATION SINCE 20 YRS.

12. … 6 JUNE 2016

13. … PT.CAME AGAIN ON 4 OCT. 2016 WITH INCREASE IN PAIN ..PT. WAS ADVISED FOR MRI & FOLLOW UP ….

14. … 4 OCT 2016

15. …. PT. AGAIN CAME ON 15 NOV.2016 WITH MRI DONE AND IS SUGESSTIVE OF B/L AVASCULAR NECROSIS & SURGERY WAS PLANNED..

16. … 15 NOV 2016

17. PT.WAS OPERATED ON 7/12/2016

18. … PT.CONTINUED TO COME FOR FOLLOW UP AND ADVICED NON WEIGHT BEARING FOR >6 WEEKS PT. CAME ON 2/3/2017 AND WAS WALKING WELL WITHOUT PAIN ON RT. SIDE BUT NOW HE WAS HAVING INCREASE IN PAIN IN LEFT SIDE SO SURGERY WAS PLANNED OF LEFT SIDE

19. … 2 MAR 2017

20. PT.CAME ON 5 APR 2017 FOR SURGERY

21. PT.WAS OPERATED ON 8 APR 2017

22. POSITIONING

23. INTRA OPERATIVE

24. ..

25. MUSCLE PEDIGRAFT

26. SCREW FIXATION

27. COMPARISON WITH THE PT. WHO HAD TO UNDERGO THR PT.CAME TO OUR HOSPITAL ON 26 TH FEB 2015 WITH C/O PAIN IN B/L HIP PAIN MORE ON THE RT.SIDE SINCE 2 MONTHS.. PT.HAD NO H/O TRAUMA NO H/O STEROID INGESION H/O ALCOHOL INGESION OVER MANY YEARS HE WAS GIVEN SYMPTOMATIC TREATMENT & ADVICED MRI & FOLLOW UP….

28. 26 TH FEB 2015

29. .. PT.NEGLECTED ADVICE & DIDN’T CAME FOR FOLLOW UP…THEN HE CAME AGAIN AFTER 1 YEAR IN MARCH 2017 WITH SEVERE PAIN AND INABILITY TO STAND OR WALK

30. PT.AGAIN CAME WITH MRI ON 28 TH APRIL 2016

31. PT.WAS OPERATED ON RT HIP- THR ON 29 TH APRIL 2017 AND PLANNED FOR LT HIP POST OP X-RAY-29 APR 2017