Abstract
Retrograde drilling of anecrotic zone within the femoral head to reduce intraosseous pressure and stimulate revascularization. Atraumatic osteonecrosis of the hip ARCO stageI (reversible) and ARCO stageII (potentially reversible) with amedial or central necrotic zone <30% or ARCO stageIII with asubchondral fracture for reduction of pain. ARCO stageIIIC, ARCO stageIV (secondary osteoarthritis), stage-independent necrotic zone > 30%, infections. Supine position. Visualization of the necrotic zone via an image intensifier, approach is determined by using a Kirschner wire, laterodorsal skin incision on alevel with the wire, longitudinal incision of iliotibial band and vastus lateralis muscle, drilling the necrotic zone with a2-3 mm Kirschner wire, optionally placing more wires or ahollow drill, wound closure. Partial weightbearing with 20 kg for 6weeks due to risk of fracture, followed by avoidance of jumping or sprinting for another 6weeks; physiotherapy from day1 after surgery, thromboembolic prophylaxis until full weightbearing is possible. Results are dependent on ARCO stages and are promising in early stages.
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