Core Decompression in Osteonecrosis of the Femoral Head Where Do We Stand Today?

Abstract

Early diagnosis and treatment with hip preservation procedures is the goal of osteonecrosis hip. Core decompression (CD) of the femoral head is a cost-effective procedure that reduces the intraosseous pressure, promotes neoangiogenesis, and enhances new bone formation. The need for the conversion of the total hip arthroplasty in the early-stage osteonecrosis hip is around 38% after an average follow-up of 26 months. The current techniques of CD involve multiple drilling (3 mm Steinmann pin) or drilling with large diame-ter reamers (5.0–7.2 mm) and numerous cellular and noncellular orthobiologic product instillations into the core tracks. The augmented CD with bone marrow aspirate concentrate (BMAC) or bone-marrow-derived mixed connective tissue progenitor’s cells instillation has consistently shown superior outcomes in early-stage osteonecrosis of the femoral head (ONFH; Ficat stage I and II and Association Research Circulation Osseous [ARCO] stage I and II). However, to date, no conclusive evidence supporting other orthobiologic products (platelet-rich plasma, bone morphogenetic protein, and tantalum) in ONFH is shown.