Hip Arthroscopy and Core Decompression for Avascular Necrosis of the Femoral Head Using a Specific Aiming Guide: A Step-by-Step Surgical Technique

Abstract

Avascular necrosis of the femoral (AVN) head is a disabling disease that affects function, mobility, and quality of life in the young adult. Its pathology involves blood circulation disruption of the femoral head and subchondral infarction. This leads to cartilage thinning, femoral head depression, and cartilage breakage, which results in hip osteoarthritis. In the past decade the prevalence of intraarticular pathology has been almost 95%, this revealed with hip arthroscopy (HA). HA and core decompression (CD) of the femoral head can be used effectively and concomitantly to treat AVN with excellent results, HA allows for excellent visualization of the hip joint cartilage, allowing treatment of femoroacetabular impingement syndrome (FAIS) and intra-articular pathology. Our technique demonstrates that retrograde core decompression with allograft and mixed bone matrix is an excellent choice of treatment in the early stages of AVN/ ONFH. The femoral headespecific aiming guide is very reliable, is simple to use arthroscopically if placed in the posterolateral portal of the hip, and offers exact pin placement at the necrotic site, as well as less operative time and less radiation to the patient and surgical team.

Endoscopic Sequential Decompression of Avascular Necrosis of the Femoral Head of Nontraumatic Origin: Description of a Surgical Technique

“…In addition, the use of an endoscope improves visualization during the procedure, which enables the identification and treatment of intra-articular injuries during the same surgery. These advantages of combining the core decompression technique with hip arthroscopy had already been described by Salas et al, 14 who established a guide for the creation of the tunnels through the posterolateral portal to have better access to the necrotic tissue.…”

“…F indicates female; M, male; mHHs, Modified Harris Hip Score; pre, pre-sequential; post, post-sequential; VAS, Visual Analogue Scale. had already been described by Salas et al, 14 who established a guide for the creation of the tunnels through the posterolateral portal to have better access to the necrotic tissue.…”

Rare Bi-focal Presentation of Avascular Necrosis of the Femoral Head: Successful Targeted Treatment as per the Diamond Concept and Review of the Literature

“…The objective of decompression is to create a channel into the necrotic lesion to relieve intraosseous pressure and to provide a pathway to restore blood flow to the diseased bone [ 17 ]. In a meta-analysis of 24 reports analysing 239 patients at stage II (Ficat-Arlet), decompression has been shown to be successful in 65% with respect to femoral head survival [ 18 ].…”

Computer-Assisted and Hip Arthroscopy for Avascular Necrosis of the Femoral Head With Femoroacetabular Impingement

“…In core decompression, traditional fluoroscopy is still used to assist positioning, or in combination with arthroscopy. 22 This may require perspective to complete the positioning, and repeated penetration of the guide may lead to bone destruction or inaccurate positioning. In our technique, the TIANVI orthopaedic surgery robot is used for positioning, which only needs 2 times the perspective to complete the positioning and calculate the penetration depth of the guide needle.…”