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Arthroscopic "Trap-less" Trapdoor Procedure for Pre-collapse Osteonecrosis of the Femoral Head

February 19, 2016

Contributors: Dean K Matsuda, MD; Dean K Matsuda, MD

Osteonecrosis of the femoral head (ONFH) is an unsolved problem. Moderate to large areas of avascular necrosis may lead to subchondral collapse and subsequent need for total hip arthroplasty in often young adult patients. A case of a 25 year old man with unilateral pre-collapse ONFH is treated with arthroscopic surgery and percutaneous core decompression plus injection of calcium sulfate/phosphate regenerative graft cement and locally harvested bone graft. Recently developed minimally invasive techniques for removal of osteonecrotic bone tissue are demonstrated prior to bone grafting. The trapdoor procedure done via open hip surgical dislocation can now be performed in a "trap-less" manner using outpatient arthroscopic and minimally invasive techniques. Advantages include the arthroscopic ability to readily assess and localize the overlying articular cartilage, treat co-existent intra-articular pathology, facilitate accurate guide pin placement and osteonecrotic bone removal without joint penetration, and potential protection against early subchondral collapse.

Results for "Hip Preservation"

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