Two-year follow-up after advanced core decompression

Area of Science:

• Orthopedic Surgery
• Regenerative Medicine
• Biomaterials Science

Background:

• Osteonecrosis of the femoral head (AVN) involves bone death, often leading to femoral head collapse.
• Advanced Core Decompression (ACD) is a minimally invasive technique aiming to remove necrotic tissue and promote healing.
• ACD utilizes a percutaneous expandable reamer and bone-graft substitutes for AVN treatment.

Observation:

• A study included 72 hips from 60 patients with AVN treated with ACD, followed for an average of 29.14 months.
• Patients were assessed preoperatively, at six weeks post-surgery, and at two further follow-ups.
• Femoral head collapse occurred in 33% of hips, with larger necrotic defects showing a significantly higher collapse rate.

Findings:

• The success of ACD in treating AVN is significantly influenced by the size of the necrotic defect.
• Larger defects were associated with a higher incidence of femoral head collapse.
• Clinical outcomes were dependent on both defect size and the stage of AVN disease progression.

Implications:

• Current ACD techniques have not demonstrated a significant improvement in success rates over standard core decompression.
• Patient selection based on necrotic lesion size is crucial for optimizing ACD outcomes in AVN.
• Further research is needed to enhance ACD efficacy for larger defects in AVN treatment.