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Arthroscopic-Assisted Core Decompression for Osteonecrosis of the Femoral Head

February 01, 2014

Contributors: Anil Gupta, MD, MBA; Joshua Harris, MD; Frank McCormick, MD; Richard C. Mather, III, MD; Shane Jay Nho, MD, FAAOS; Rachel M Frank, MD; Rachel M Frank, MD

The management of precollapse osteonecrosis of the femoral head is controversial. Core decompression is a surgical technique with which the necrotic lesion is reamed or drilled to decrease local intraosseous pressure and stimulate a vascularized healing response. This technique has demonstrated efficacy in delaying early subchondral collapse, which ultimately may delay or prevent the development of osteoarthritis. Advantages of arthroscopic-assisted core decompression include direct visualization of the articular surface as well as direct visual guidance during reaming and curettage. Further, the use of arthroscopy allows the ability to address any concomitant soft-tissue or bony pathology associated with or in addition to the osteonecrotic lesion. This video describes the presentation, imaging findings, and arthroscopic findings typically encountered in patients with precollapse femoral head osteonecrosis. A step-by-step guide to performing arthroscopically assisted core decompression is presented, complete with common pearls and pitfalls. Finally, the typical postoperative course and rehabilitation protocol following this procedure will be reviewed. Overall, arthroscopically assisted core decompression of the femoral head for precollapse osteonecrosis provides the added advantage of intra-articular visualization to confirm the diagnosis, allows for treatment of associated bony and soft-tissue pathology, and decreases risk for joint penetration in carefully selected patients.

Results for "Hip Preservation"

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