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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 is an unsolved problem. Moderate to large areas of osteonecrosis may lead to subchondral collapse and subsequent need for total hip arthroplasty, often in young adults. This video reviews the case presentation of a 25-year-old man with unilateral precollapse osteonecrosis of the femoral head who was treated via arthroscopic surgery, percutaneous core decompression, and injection of calcium sulfate/phosphate regenerative graft cement and locally harvested bone graft. Recently developed minimally invasive techniques for the removal of osteonecrotic bone tissue are performed before bone grafting. The trapdoor procedure is performed via open hip surgical dislocation and currently can be performed in a "trap-less" manner via outpatient arthroscopic and minimally invasive techniques. Advantages of the procedure include arthroscopic ability to readily assess and localize the overlying articular cartilage, manage coexisting intra-articular pathology, facilitate accurate guide pin placement and osteonecrotic bone removal without joint penetration, and protect against early subchondral collapse.

Results for "Hip Preservation"

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