[Role of core decompression as treatment method for ischemic femur head necrosis]

Nontraumatic ischemic necrosis of the femoral head remains a source of much controversy. The etiology is also controversial. Possibilities are: hypertrophy of intraosseous structures (lipocytes, hematopoietic elements), creating intraosseous hypertension; alcohol and steroids as toxic agents; circulating fat globules embolizing the microcirculation of the metaphysis. The disease appears most frequently in young adults, but no satisfactory nonoperative treatment modalities have been reported as yet. In 1971, Ficat and Arlet published their results on core decompression performed in 100 patients, with a follow-up of from 1 to 5 years. The results for those with stage I disease (n = 40) were good or excellent in 88% of the patients. The results for those with stage II disease (n = 16) were good or excellent in 69%. Based on current experience, the treatment is to be recommended for patients with pre-collapse stages 0, I and IIA of ischemic necrosis of the femoral head. For stage III disease, the procedure may reduce pain at night and at rest and can be considered in patients wishing to avoid total hip arthroplasty for a period of time.