Core Decompression as Treatment in Avascular Necrosis of the Femoral Head

Mustafa elsagair; Hamza elnaas; Yousif algweel

المؤلفون

Mustafa elsagair Aljazeera orthopedic hospital And misurata medical centre
Hamza elnaas Aljazeera orthopedic hospital And misurata medical centre
Yousif algweel Aljazeera orthopedic hospital And misurata medical centre

الملخص

Core decompression is a minimally invasive surgical procedure commonly used to treat avascular necrosis (AVN) of the femoral head, a condition caused by disrupted blood supply leading to bone death and eventual joint collapse. The procedure involves drilling one or more small channels into the necrotic bone to relieve intraosseous pressure, enhance vascularization, and stimulate the formation of new bone tissue. Core decompression is most effective in the early stages of AVN (Ficat stages I and II), where joint collapse has not occurred.

Clinical outcomes :

suggest significant pain relief and improved function in patients with early-stage AVN. When combined with adjunct therapies, such as bone grafts, stem cells, or biologics, the success rate improves further. While it is generally considered safe,

complications :

such as fractures are possible. This review highlights the indications, technique, efficacy, and potential complications of core decompression for AVN of the femoral head.

السيرة الشخصية للمؤلف

Hamza elnaas، Aljazeera orthopedic hospital And misurata medical centre

المراجع

. Adelani MA, Keeney JA, Palisch A, Fowler SA, Clohisy JC. Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res. 2013;471(8):2595–601.

. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5.

. Herndon JH, Aufranc OE. Avascular necrosis of the femoral head in the adult. A review of its incidence in a variety of conditions.Clin Orthop Relat Res 1972;86:43–62. [CrossRef ]

. Mwale F, Wang H, Johnson AJ, Mont MA, Antoniou J. Abnor-mal vascular endothelial growth factor expression in mesenchymalstem cells from both osteonecrotic and osteoarthritic hips. Bull NYU Hosp Jt Dis 2011;69:S56–61.

. Bradway JK, Morrey BF. The natural history of the silent hip in bilateral atraumatic oste-onecrosis. J Arthroplasty 1993;8:383–7. [CrossRef]

. Lieberman JR, Berry DJ, Mont MA, Aaron RK, Callaghan JJ, Rajadhyaksha AD, et al. Osteonecrosis of the hip: management in the 21st century. Instr Course Lect 2003;52:337–55.

. Arbab D, Kِ¸ nig DP. Atraumatic Femoral Head Necrosis in Adults. Dtsch Arztebl Int 2016;113:31–8. [CrossRef ]

. Moya-Angeler J, Gianakos AL, Villa JC, Ni A, Lane JM. Current concepts on osteonecro-sis of the femoral head. World J Orthop 2015;6:590–601. [CrossRef ]

. Mont MA, Jones LC, Sotereanos DG, Amstutz HC, Hungerford DS. Understanding and treating osteonecrosis of the femoral head. Instr Course Lect 2000;49:169–85.

. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompres-sion for ischaemic necrosis of the femoral head. J Bone Joint Surg Br 1995;77:42–9. [CrossRef ]

. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg Br 1985;67:3–9. [CrossRef ]

. Harris WH. Traumatic arthritis of the hip after dislocation and acetabularfractures: treatment by mold arthroplasty. An end-result studyusing a new method of result evaluation. J Bone Joint Surg Am 1969;51:737–55. [Cr

. Malkiewicz A, Dziedzic M. Bone marrow reconversion - imaging of physiological changes in bone marrow. Pol J Radiol. 2012;77(4):45–50.

. Landgraeber S, Tran TN, Classen T, Warwas S, Theysohn J, Lazik A, Jager M, Kowalczyk W. Geometric analysis of an expandable reamer for treatment of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 201135(10):1357–62.

. Rijnen WH, Gardeniers JW, Buma P, Yamano K, Slooff TJ, Schreurs BW. Treatment of femoral head osteonecrosis using bone impaction grafting. Clin Orthop Relat Res. 2003;417:74–83.

. Mont MA, Etienne G, Ragland PS. Outcome of nonvascularized bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2003; 417:84–92.

. Rosenwasser MP, Garino JP, Kiernan HA, Michelsen CB. Long term followup of thorough debridement and cancellous bone grafting of the femoral

. Pouya F, Kerachian MA. Avascular necrosis of the femoralhead: are any genes involved? Arch Bone Jt Surg.2015;3(3):149–55.4.

. Shah KN, Racine J, Jones LC, Aaron RK. Pathophysiology andrisk factors for osteonecrosis. Curr Rev Musculoskelet Med.2015;8(3):201–9.5.

. Hungerford DS. Response: the role of core descompression inthe treatment of ischemic necrosis of the femoral head.Arthritis Rheum. 1989;32(6):801–6.6.

. Specchiulli F, Capocasale N, Laforgia R, Solarino GB. Thesurgical treatment of idiopathic osteonecrosis of the femoralhead. Ital J Orthop Traumatol. 1987;13(3):345–51.7

. Tooke SM, Nugent PJ, Bassett LW, Nottingham P, Mirra J,Jinnah R. Results of core decompression for femoral headosteonecrosis. Clin Orthop Relat Res. 1988;(228):99–104.8.

. Warner JJ, Philip JH, Brodsky GL, Thornhill TS. Studies ofnontraumatic osteonecrosis. The role of core decompressionin the treatment of nontraumatic osteonecrosis of thefemoral head. Clin Orthop Relat Res. 1987;(225):104–27.9.

. Chotivichit A, Korwutthikulrangsri E, PornrattanamaneewongC, Achawakulthep C. Core decompression with bone marrowinjection for the treatment of femoral head osteonecrosis. JMed Assoc Thai. 2014;97 Suppl 9:S139–43.10. Saito S, Ohzono K, Ono K. Joint-preserving operations foridiopathic avascular necrosis of the femoral head.