Core decompression with bone grafting for osteonecrosis of the femoral head

Although core decompression is one of the more popular procedures for treat ing avascular necrosis, considerable controversy exists concerning its safe ty and effectiveness. The current authors review the results of a prospecti ve study of 406 hips in 285 patients treated by one surgeon with core decom pression and bone grafting. Patients were followed up for 2 to 14 years. Th e outcome was determined by the change in the Harris hip score, quantitativ e radiographic measurements, and need for total hip replacement. These hips were compared with 55 hips in 39 patients treated non-operatively and with historic controls. Five complications occurred after 406 procedures includ ing two fractures that resulted from falls during the first postoperative m onth. Of the 312 hips in 208 patients with a minimum 2-year followup, 36% o f hips (113 hips in 90 patients) required hip replacement at a mean of 29 m onths: 18 of 65 hips (28%) with Stage I disease; 45 of 133 hips (34%) with Stage II disease; three of 13 hips (23%) with Stage III disease; and 45 of 92 hips (49%) with Stage IV disease. Before femoral head collapse (Stages I and II combined) hip replacement was performed in 10 of 77 hips (14%) with small lesions (A), 33 of 68 hips (48%) with intermediate lesions (B), and 20 of 48 hips (42%) with large lesions (C). Results as determined by change s in Harris hip scores and radiographic progression were similar. Patients who underwent core decompression and bone grafting have a very low complica tion rate. In patients treated before femoral head collapse, the outcome is significantly better than in patients who received symptomatic treatment. The results are correlated with the stage and the size of the necrotic lesi on.