[Core decompression ("conventional method") in atraumatic osteonecrosis of the hip]

Area of Science:

• Orthopedic surgery
• Hip joint pathology
• Bone healing and revascularization

Background:

• Osteonecrosis of the femoral head (ONFH) leads to hip pain and joint destruction.
• Early stages of ONFH involve reversible or potentially reversible necrotic zones.
• Intraosseous pressure elevation and impaired revascularization are key pathological features.

Purpose of the Study:

• To evaluate retrograde drilling of the necrotic zone in the femoral head.
• To reduce intraosseous pressure and promote revascularization in osteonecrosis.
• To assess the efficacy of this technique in early-stage ONFH.

Main Methods:

• The study involves retrograde drilling of the necrotic femoral head zone using Kirschner wires.
• Indications include ARCO stages I, II, and selected stage III ONFH with limited necrosis.
• Contraindications include advanced stages (III C, IV), extensive necrosis (>30%), and infection.

Main Results:

• Results are contingent upon the specific ARCO stage of osteonecrosis.
• The technique shows promising outcomes in the earlier, reversible stages of ONFH.
• Further data is needed for advanced stages and specific fracture subtypes.

Conclusions:

• Retrograde drilling is a viable option for managing early-stage osteonecrosis of the femoral head.
• The procedure aims to preserve the native joint by stimulating bone healing.
• Patient selection based on ARCO staging is crucial for optimal outcomes.