Evaluation of core decompression for early osteonecrosis of the femoral head

Twenty-six hips (19 patients) with osteonecrosis of the femoral head with s tage I or II of the disease, according to the Ficat and Arlet classificatio n, underwent core decompression. Osteonecrosis was confirmed histologically in all 26 hips. Of 19 patients, 7 had prognostic factors traditionally ass ociated with poor outcome including collagen vascular disease and continued use of steroids. The follow-up period averaged 7 years 10 months (range: 2 years 5 months-13 years 8 months) for 17 patients with 24 hips. Two patien ts died secondary to systemic illness. Seventeen hips (65.4%) had very good or good results using the Ficat criteria. Eight hips (30.8%) needed furthe r operation [total hip arthroplasty (THA) for 7 hips, osteotomy for 1 hip]. Of the 12 hips in patients who had used steroids, 6 hips (50%) were conver ted to THA. Four hips in patients with systemic lupus erythematosus (SLE) n eeded THA (100%). We conclude that core decompression provides an effective treatment for steroid-associated osteonecrosis other than in cases with SL E, as well as providing effective treatment for non-steroid-associated oste onecrosis in the early stages of the disease.