Biostructural augmentation for the treatment of osteonecrosis: rationale, technique, and case example

Avascular necrosis of the hip is a common disease that usually affects a young and active patient population. As the disease progresses, the undermined structural integrity of the subchondral bone leads to articular collapse and subsequent osteoarthrosis. The ideal treatment is one that hinders or arrests the progression of the disease, averting articular collapse and joint replacement surgery. A surgical strategy is described that attempts to address the multiple factors involved in the progression of the disease. This is accomplished through a modified core decompression procedure combined with the insertion of two interference screws into the subchondral plate to provide structural support and the use of osteoinductive material (i.e., demineralized bone matrix) in an effort to accelerate the bone healing process.