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Hip Arthroscopy and Core Decompression for Avascular Necrosis of the Femoral Head Using a Specific Aiming Guide: A
Antonio Porthos Salas1, Jacek Mazek2,3, John O'Donnell4
1Hip Arthroscopy Mexico, San Pedro Garza García, México.
Insights
Avascular necrosis of the femoral head (AVN) can be effectively treated using arthroscopic hip surgery combined with core decompression. This approach offers precise targeting of necrotic areas, improving outcomes for young adults.
Area of Science:
- Orthopedics
- Regenerative Medicine
- Biomaterials Science
Background:
- Avascular necrosis (AVN) of the femoral head is a debilitating condition causing hip osteoarthritis, particularly in young adults.
- Disrupted blood supply leads to subchondral infarction, cartilage damage, and impaired mobility.
- Intra-articular pathologies are prevalent in nearly 95% of AVN cases, often requiring arthroscopic intervention.
Purpose of the Study:
- To evaluate the efficacy of a novel technique combining arthroscopic hip surgery with retrograde core decompression for early-stage AVN of the femoral head.
- To assess the utility of a femoral head-specific aiming guide for precise pin placement during arthroscopic core decompression.
Main Methods:
- A cohort of patients with early-stage AVN/ONFH underwent concomitant hip arthroscopy (HA) and retrograde core decompression (CD).
- The procedure utilized an allograft and mixed bone matrix for bone regeneration.
- A femoral head-specific aiming guide was employed for accurate placement of the decompression pin via the posterolateral portal.
Main Results:
- The described technique demonstrated excellent results in treating early-stage AVN/ONFH.
- The femoral head-specific aiming guide proved reliable and simple to use arthroscopically.
- The method allowed for exact pin placement at the necrotic site, reducing operative time and radiation exposure.
Conclusions:
- Retrograde core decompression with allograft and mixed bone matrix, facilitated by an arthroscopic aiming guide, is an effective treatment for early AVN/ONFH.
- This combined approach addresses both intra-articular pathology and the underlying bone necrosis, preserving joint function.
Abstract:
Avascular necrosis of the femoral (AVN) head is a disabling disease that affects function, mobility, and quality of life in the young adult. Its pathology involves blood circulation disruption of the femoral head and subchondral infarction. This leads to cartilage thinning, femoral head depression, and cartilage breakage, which results in hip osteoarthritis. In the past decade the prevalence of intraarticular pathology has been almost 95%, this revealed with hip arthroscopy (HA). HA and core decompression (CD) of the femoral head can be used effectively and concomitantly to treat AVN with excellent results, HA allows for excellent visualization of the hip joint cartilage, allowing treatment of femoroacetabular impingement syndrome (FAIS) and intra-articular pathology. Our technique demonstrates that retrograde core decompression with allograft and mixed bone matrix is an excellent choice of treatment in the early stages of AVN/ONFH. The femoral head-specific aiming guide is very reliable, is simple to use arthroscopically if placed in the posterolateral portal of the hip, and offers exact pin placement at the necrotic site, as well as less operative time and less radiation to the patient and surgical team.
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