Core Decompression for Osteonecrosis of the Femoral Head

Osteonecrosis, also known as avascular necrosis (AVN), of the femoral head occurs due to a reduced blood supply, leading to bone death, increased intraosseous pressure, and collapse. Primary risk factors include prolonged corticosteroid use, excessive alcohol consumption, and trauma-among various other causes. Core decompression is an effective treatment for relieving pressure and stimulating healing in the early stages of osteoarthritis.

Core decompression for AVN is indicated for precollapse stages, such as Association Research Circulation Osseous (ARCO) 1 and 2. However, it is typically contraindicated in later, postcollapse stages, such as ARCO 3 and 4.

In the supine position on a hip arthroscopy table with a post, traction can be applied to the operative limb, and any concomitant intracapsular pathology can be addressed before core decompression. A lateral incision is made over the proximal femur at the level of the greater trochanter. A guidewire is introduced into the necrotic region of the femoral head under fluoroscopic guidance. A lateral reamer is used to drill from the lateral cortex to beneath the subchondral surface. An expandable reamer and curettes are used to remove necrotic bone. Calcium phosphate bone graft substitute was injected into the femoral head and allowed to cure.

Overall, after core decompression for AVN, most patients demonstrate significant improvements in patient-reported outcomes (PROs) at a 2-year follow-up. The radiographic survival rate has been reported to be >76.9% at a 2-year follow-up. Total hip arthroplasty survival rates have been reported to be >72.1% at a 2-year follow-up.

Core decompression is an effective early-stage intervention for AVN of the femoral head, resulting in significant improvements in PROs and high radiographic survival rates at a 2-year follow-up. Future research may investigate optimal patient selection and high-quality studies exploring adjunctive therapies to maximize long-term outcomes.

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