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Osteonecrosis after powered core decompression
William M Mihalko1, Lucy Balos, Mario Santilli
1Department of Orthopaedic Surgery, State University of New York at Buffalo, USA.
Clinical Orthopaedics and Related Research
|July 3, 2003
Summary
Core decompression for osteonecrosis can cause additional bone death. A powered trephine lodged in a patient's femur may have iatrogenically induced further femoral head necrosis.
Area of Science:
- Orthopedic Surgery
- Bone Pathology
Background:
- Osteonecrosis of the femoral head (ONFH) is a debilitating condition often requiring surgical intervention.
- Core decompression is a common procedure to relieve pressure and potentially halt necrosis progression.
- Alcohol-related ONFH, Ficat Stage 2, was treated with femoral head decompression.
Observation:
- A 1/4-inch trephine became lodged and heated during femoral head decompression.
- The trephine was difficult to remove.
- The patient later experienced progressive pain and ambulation difficulty.
Findings:
- Radiographs showed increased density around the decompression track.
- Histology revealed 2.7 cm of unrepaired necrotic bone surrounding the track.
- Extensive iatrogenic osteonecrosis secondary to the procedure was suspected.
Implications:
- Powered trephine use in core decompression may risk iatrogenic femoral head necrosis.
- Heat generation or pressure from the trephine are potential causative mechanisms.
- This case highlights a rare complication of femoral head core decompression.