Arthroscopic Core Decompression for Avascular Necrosis of the Femoral Head Using Multiple Small-Diameter Tunnels

Day, Hannah K.; Shelton, Trevor J.; Comfort, Spencer M.; Melugin, Heath P.; Rutledge, Joan C.; Ruzbarsky, Joseph J.; Philippon, Marc J.

doi:10.1016/j.eats.2022.06.021

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…Recently, Day et al 15 proposed a new endoscopic approach for the treatment of cases with NAVNT using multiple small-diameter tunnels, describing a combined procedure for cases with NAVNT and femoroacetabular impingement. Although the authors also described the use of capsulotomy and decortication as part of their technique, these were performed for the treatment of femoroacetabular impingement lesions, and they did not conceive of them for the treatment of NAVNT.…”

Section: Discussionmentioning

confidence: 99%

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

Aguilera-Bohórquez,

Sigüenza,

Gerstner-Saucedo

et al. 2023

Techniques in Orthopaedics

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Introduction: Treatment options for nontraumatic avascular necrosis of the femoral head (NAVNT) aim to reduce intraosseous pressure and restore vascular flow to prevent the collapse of the femoral head. The objective of this study was to describe a modification of the standard central decompression technique, called sequential decompression, in patients with NAVNT. Materials and Methods: Sequential decompression consists of 4 stages: (1) negative pressure release with capsulotomy, (2) bone decompression by removing the cortical from the anterior superior part of the femoral head-neck junction, (3) intramedullary decompression and stimulation of osteogenesis through tunnels from the anterolateral aspect of the femoral neck, and (4) stimulation of angiogenesis with the application of platelet-rich plasma in the subchondral plate. Results: Five cases (4 men and 1 woman, age: 28.8±16.4 y) were treated with the sequential decompression technique. A decrease in pain and an improvement in function were observed in all cases. Conclusion: We believe that the approach offered by sequential decompression impacts the different pathophysiological pathways of NAVNT, which helps control intraosseous pressure, removal of necrotic tissue, stimulation of angiogenesis, and bone regeneration. Level of Evidence: Level V, expert opinion.

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Section: Discussionmentioning

confidence: 99%