Modified advanced core decompression (mACD)

Abstract

The modified advanced core decompression (mACD) combines the advantages of alow invasive core decompression with maximal removal of osteonecrotic bone and abiologic reconstruction of the resulting bone defect. Avascular (atraumatic) osteonecrosis of the femoral head (ARCO stageII). Subchondral fractures (ARCO stageIII); advanced osteoarthritis (e.g., ACRO stageIV); persisting risk factors such as high-dose corticoid therapy, chemotherapy, alcohol abuse; open growth plates; history of side effects or intolerance to components of the applied bone substitute; lack of patient compliance; osteomyelitis or other septic conditions. Supine positioning on the operation table, skin disinfection, and sterile draping. Skin incision and core decompression using a3.2 mm guide wire. Removal of abone cylinder from anonaffected area of the femoral neck using ahollow trephine. Drilling of the osteonecrotic area over the applied wire up to 5 mm to the subchondral bone under fluoroscopy, insertion of an expandable bone knife and removal of the osteonecrotic bone supported by acurette. Bone grafting of the autologous bone into the subchondral defect zone and filling of the drill canal by resorbable bone substitute. Bed rest for 24 h, then partial weight bearing (20 kg) on crutches for 2-6weeks depending on the bone quality in the defect zone and the applied bone substitute. Midterm superiority (2years) in hip survival of the mACD over advanced core depression and core depression, especially in ARCO stageII.