PREVENTING COLLAPSE IN EARLY OSTEONECROSIS OF THE FEMORAL-HEAD - A RANDOMIZED CLINICAL-TRIAL OF CORE DECOMPRESSION

We performed a randomised trial on 37 hips (33 patients) with early-st age osteonecrosis (ON). After the initial clinical evaluation, includi ng plain radiography and MRI, 18 hips were randomly assigned to a core -decompression group and 19 to a conservatively-treated group. All the patients were regularly followed up by clinical evaluation, plain rad iography and MRI at intervals of three months. Hip pain was relieved i n nine out of ten initially symptomatic hips in the core-decompression group but persisted in three out of four initially painful hips in th e conservatively-treated group at the second assessment (p < 0.05). At a minimum follow-up of 24 months, 14 of the 18 core-decompressed hips (78%) and 15 of the 19 non-operated hips (79%) developed collapse of the femoral head. By survival analysis, there was no significant diffe rence in the time to collapse between the two groups (log-rank test p = 0.79). Core decompression may be effective in symptomatic relief, bu t is of no greater value than conservative management in preventing co llapse in early osteonecrosis of the femoral head.