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The Journal of Bone and Joint Surgery, Vol 68, Issue 9 1313-1319, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Core decompression of the femoral head for osteonecrosis
JF Camp and CW Colwell
The results of forty core-decompression procedures that were performed for
ischemic necrosis of the femoral head in thirty-one patients over a
four-year period were retrospectively reviewed to ascertain the
effectiveness of the procedure. The data did not support the published
rates of success of the procedure for Stage-1 and Stage-2 lesions. With a
mean length of follow-up of eighteen months, 60 per cent of the hips that
had a decompression prior to collapse of the femoral head demonstrated
progression of the lesion and were judged to be a failure by clinical or
radiographic criteria. Computerized tomographic scans and magnetic
resonance imaging proved to be 100 per cent sensitive for diagnosis in
preoperative testing; isotopic bone-scanning was less sensitive (80 per
cent). Functional intraoperative testing by the method of Ficat did not
provide added sensitivity or specificity to the results of the preoperative
bone scan. A postoperative or intraoperative fracture occurred in four
hips, for an incidence that exceeded any in previously published reports.
We concluded that core decompression should be considered a relatively
ineffective procedure with significant morbidity.
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