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Efficacy of core decompression as treatment for osteonecrosis of the hip: a systematic review

Manoj Rajagopal1, Julie Balch Samora, Thomas J Ellis

  • 1Department of Orthopaedics, The Ohio State University, Columbus, OH 43210, USA.

Hip International : the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
|October 27, 2012
PubMed

Insights

Core decompression (CD) for hip osteonecrosis offers some pain relief but often requires further treatment. Early-stage disease with smaller lesions shows better outcomes with CD, though long-term data is limited.

Area of Science:

  • Orthopedic Surgery
  • Bone Diseases
  • Hip Joint Disorders

Background:

  • Core decompression (CD) has been a surgical treatment for osteonecrosis of the hip since the 1960s.
  • Osteonecrosis of the hip (ON) can lead to significant pain and disability, often necessitating total hip arthroplasty (THA).

Purpose of the Study:

  • To systematically review the effectiveness of core decompression (CD) in treating osteonecrosis of the hip (ON).
  • To evaluate CD's impact on pain relief, the need for total hip arthroplasty (THA), and necrotic lesion characteristics (size and Ficat stage).

Main Methods:

  • Systematic review of literature evaluating core decompression for hip osteonecrosis.
  • Inclusion criteria focused on studies reporting outcomes related to pain, THA, lesion size, and Ficat stage.
  • Analysis of four Level IV evidence articles encompassing 139 total cases.

Main Results:

  • Three of the four included studies reported some improvement in outcomes following CD.
  • Overall outcomes were rated as 'good' in only one study, with others reporting 'fair' or 'poor' results.
  • A significant proportion of patients (25.8%) ultimately required THA, and patients with necrotic lesion size <50% demonstrated better outcomes with CD.

Conclusions:

  • Core decompression (CD) may serve as a treatment option to prevent THA in early stages of osteonecrosis of the hip (ON).
  • However, current evidence is limited to low-level studies (Level IV), and rigorous long-term outcome data is lacking.
  • Further high-quality research is needed to establish CD as a definitive treatment for hip osteonecrosis.

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