Osteonecrosis of the Femoral Head: Core Decompression Systems

Osteonecrosis of the femoral head (ONFH) is a chronic progressive debilitating disease that often affects young and active patients. It results from vascular interruption to the femoral head and can be caused by trauma, chronic corticosteroid use, chronic alcoholism, and coagulopathies. Treatment includes core decompression, a surgical procedure that may help delay or forestall disease progression if performed at the early stages of the disease. Technological advances have made the procedure more efficient and effective. There are several core decompression systems available in the market, giving healthcare providers options for core decompression technique: (1) The PerFuse™ Percutaneous Decompression System (Zimmer Biomet, Warsaw, Indiana) offers the advantage of utilizing autologous stem cell progenitor augmentation which has been shown to provide clinical benefits to patients; (2) The Advanced Core Decompression System (Stryker, Kalamazoo, Michigan) utilizes synthetic regenerative bone grafts, and these calcium-based synthetic grafts are well-accepted as the adjuvant modality for small defects; and (3) The Avascular Necrosis/Osteonecrosis Core Decompression Expandable Reamer System (Arthrex Inc., Naples, Florida) offers the unique ability for endoscopic-assisted core decompression, which may provide increased ability to treat early-stage ONFH by identifying necrotic lesions not visible radiographically. The preferred management of ONFH remains a topic of controversy and is reliant on the disease stage. Future randomized clinical trials comparing various core decompressions systems, with or without the use of bone marrow aspirates and arthro-endoscopy, may provide insight into the true clinical benefits of each method.