Core decompression of femoral head for avascular necrosis
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Avascular necrosis (AVN) most commonly affects the hip joint. It accounts for between 5 and 12% of total hip arthroplasties. This equates to approximately 15,000 new cases in the US each year. The aetiology and pathogenesis are still unclear but a number of risk factors have been identified. These include trauma (intra capsular neck of femur), smoking, corticosteroids, alcohol abuse, haemaglobinopathy, autoimmune disease, Gauchers disease and Caisson disease. Corticosteroids and alcohol account for up to 90% of non traumatic cases.
Several joint preserving techniques have been described. There is little evidence to prove that any single technique has a clear advantage. Core decompression is the most simple and associated with the least morbidity.
The results of all joint preservation techniques for AVN are better for small lesions and early stage disease.
Author:Christopher Edward Bache FRCS (Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK.