Osteonecrosis of the Femoral Head (Part 2)

Abstract

Although there is no completely effective treatment for osteonecrosis (ON), core decompression is one of the more popular methods used to promote healing and retard progression. However, there has been considerable controversy about its safety and effectiveness. Published reports have indicated clinical success which has varied from 40 to 90 percent. We performed core decompression with supplementary cancellous bone grafting on 406 hips with ON. There were five complications in the entire series, including two hip fractures resulting from falls. Of 297 hips with a two to fourteen year follow-up, total hip replacement was required in only 36 percent of treated hips as compared to 77 percent of non-operated controls. The outcome was correlated with both the stage and the size of the necrotic lesion. Only 22 percent of the hips with small lesions required total hip replacement as compared to 39 percent with intermediate or large lesions. There was no correlation between outcome and the amount of pain present prior to surgery.Various modifications of core decompression have also been used to treat ON. These have included the use of supplementary grafts of various types, electrical stimulation, decalcified bone matrix, and bone morphogenic protein. Early results in limited series have been encouraging, but some of those techniques remain experimental.At the present time we feel that core decompression, with or without bone grafting, is a simple, safe, and established technique which is our first choice for the treatment of patients with earlier stages of ON. The role of vascularized fibular grafts is promising and the place of other new techniques is currently being evaluated.