Core decompression for the treatment of avascular necrosis of the femoral head

Abstract

Abstract Core decompression for the treatment of avascular necrosis of the femoral head was introduced by Ficat and Arlet in 1962 with results first reported in 1968. Since 1973 the author has used the technique with good results in the precollapse stage and a low complication rate. The recent literature has reported varied results. Bone functions as a closed compartment (as a Starling resistor). Markedly elevated bone marrow pressures have been recorded in all stages of avascular necrosis of the femoral head, making core decompression a rational procedure. However, to avoid the pitfalls, the following precautions must be exercised: (a) biplane image intensification avoids articular perforation; (b) clearance of the coring device avoids femoral head blow-out; and (c) metaphyseal rather than diaphyseal entry site dramatically lowers the incidence of secondary fracture. Core decompression in the author's experience provides an effective procedure with low morbidity in the precollapse stages of the disease.