Related Experiment Video
Updated: Jun 23, 2026
Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head
Published on: April 12, 2022
Thorough debridement under endoscopic visualization with bone grafting and stabilization for femoral head
Lawrence Wells1, Harish S Hosalkar, Eileen A Crawford
1Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. WellsL@email.chop.edu
Insights
This study evaluated a new technique for treating pediatric femoral head osteonecrosis. Thorough decompression with endoscopic visualization (TDEV), bone grafting, and stabilization showed promising results for early-stage lesions.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Bone diseases
Background:
- Osteonecrosis of the femoral head is increasingly common in children due to steroid therapy, sickle cell anemia, and leukemia.
- Core decompression is a potential treatment, but optimization is needed.
- A novel technique, TDEV, was developed for enhanced core decompression.
Purpose of the Study:
- To evaluate the efficacy of TDEV combined with bone grafting and stabilization for pediatric femoral head osteonecrosis.
- To assess outcomes based on lesion severity using the Steinberg classification.
Main Methods:
- Retrospective review of 16 hips in 13 pediatric patients (< or =20 years old).
- Patients had femoral head osteonecrosis related to steroid treatment, sickle cell anemia, or leukemia.
- All underwent TDEV, cancellous bone grafting, and nail plate stabilization, followed by assessment of pain, function, and radiologic stage.
Main Results:
- Mean follow-up was 28 months.
- Most patients with successful procedures reported improved pain.
- Early-stage lesions (Steinberg stage II) showed good graft incorporation and no disease progression.
- Higher-grade lesions (Steinberg stage IIIB or higher) were associated with poorer outcomes.
Conclusions:
- TDEV with bone grafting and stabilization shows encouraging early results for pediatric femoral head osteonecrosis.
- The technique is most effective for lesions graded lower than Steinberg stage IIIB.
- TDEV is recommended for early-stage lesions by trained surgeons.
Background:
Osteonecrosis of the femoral head has become increasingly common after steroid therapy and as a consequence of improved survival in children with sickle cell anemia and leukemia. Multiple operative and nonoperative treatments have been explored in the pediatric patient population, and core decompression is a relatively safe and possibly effective option. To optimize core decompression further, we have tested a new technique involving thorough decompression of the osteonecrotic zone under endoscopic visualization (TDEV) combined with cancellous bone grafting and stabilization with a nail plate device.
Methods:
We retrospectively reviewed 16 hips in 13 patients (< or =20 years old) with femoral head osteonecrosis related to steroid treatment, sickle cell anemia, or leukemia. The Steinberg classification system was used to classify all cases. Each patient underwent TDEV, bone grafting, and stabilization of the grafting site. Patients were followed up postoperatively for changes in pain level, functional ability, and Steinberg radiologic stage.
Results:
The mean follow-up was 28 months (range, 18-49 months). All patients in whom the procedure was successful had improvement in pain symptoms at latest follow-up, except for 1. Radiologically, all Steinberg stage II cases (B and C), except for 1, demonstrated good incorporation of graft without further progression of disease. Seven of the 8 patients that showed radiologic progression and deterioration of function or progressive symptoms had grade IIIB disease or higher at the time of procedure.
Conclusions:
Our initial results demonstrate that TDEV combined with cancellous bone grafting and stabilization produces encouraging early results for pediatric patients with lesions graded lower than Steinberg stage IIIB. Our findings were less optimistic for patients with higher-grade lesions. Our recommendation, therefore, is to use TDEV by trained surgeons for treatment of early-stage lesions, preferably less than Steinberg stage IIIB.
Level Of Evidence:
Level IV, Therapeutic Study.
