Treatment of Osteonecrosis of the Femoral Head by Core Decompression, Bone Grafting,
Link http://www.uphs.upenn.edu/ortho/oj/1997/oj10sp97p24.html M. E. Steinberg, M.D., P. Larcom, M.D., B. Strafford, M.D., W. B. Hosick, M.D., A. Corces, M.D., R. E. Bands, M.D., K. Hartman
Abstract: Core decompression is one of the more popular procedures for the treatment of early stages of avascular necrosis (AVN) of the femoral head. However, the controversy regarding its safety and effectiveness continues. In an attempt to clarify the situation, we are reporting on a large series of cases performed by a single surgeon with long-term follow-up. This is a prospective study in which results have been evaluated using objective clinical parameters and quantitative radiographic measurements……Core decompression with bone grafting, if carefully performed, has a very low complication rate. In cases treated before femoral head collapse, the outcome is significantly better than with symptomatic or conservative treatment. Results are correlated with both the stage of AVN and the size of the necrotic lesion.
It is generally recognized that without specific treatment 70% to 80% of hips with clinically established avascular necrosis (AVN) will show radiologic and clinical progression. Accordingly, several prophylactic procedures have been used in the earlier stages of AVN to halt progression and encourage repair. Of these, perhaps the most frequently used to core decompression…
…After experiencing unsatisfactory outcomes in most of our patients treated with protected weight bearing alone before 1980, we began using a modified type of core decompression with supplemental bone grafting as our standard approach to the treatment of hips with earlier stages of AVN, which was later supplemented with electrical stimulation. By December 1995, this procedure had been performed on 406 hips, which form the basis of this report.
….Summary and Conclusions
If untreated, approximately 70% to 80% of hips with clinically established AVN show progression and most of these eventually require replacement arthroplasty…
…Core decompression with or without bone grafting is a simple, safe, and relatively effective method for treating early stages of AVN. Other methods of treatment are available, but most of these are more complicated and have a higher potential incidence of complications. Only if these are definitely shown to be more effective, would we advocate using these techniques rather than the technique described here. At this time, core decompression with bone grafting remains our standard approach to hips with early stages of AVN in most patients we encounter.