Core Decompression by Laser Osteoperforation: A Preliminary Report of New and Minimally Invasive Modality for the Treatment of Avascular Necrosis of the Femoral Head

Abstract

Introduction: Avascular necrosis (AVN) of the femoral head is a devastating disease that often leads to the destruction of the hip. Core decompression of femoral head is the commonest of all conservative surgical treatments where an 8-10 mm cylindrical core of bone is removed from antero-lateral segment of the femoral head. But it is employed only in early stages of the disease and its results are still of controversial efficacy and most of patients ultimately require total hip arthroplasty. Laser irradiation stimulates the reparative process in the bone and marrow while local hyperthermia produced by the laser vaporizes some of necrotic areas leading to a reduction of the intraosseous pressure which is the fulcrum of AVN regardless of the cause. Objectives: The aim of this experimental study was to evaluate the outcome of core decompression by laser osteoperforation for AVN of the femoral head. Subjects and methods: The study was carried out at the Institute of Laser Surgery and Hospital, Dhaka, Bangladesh which included 62 hips with AVN in 40 patients. Preoperative and Postoperative Clinical assessment and Radiological staging were done using 'Harris Hip Score (HHS)' and 'Ficat and Arlet staging' respectively. Under spinal anesthesia and Fluoroscopic guidance all hips were subjected to 'Core decompression by Laser Osteo-perforation' using 970 nm Diode laser through 18G spinal needle via transtrochanteric and trans-capital approach. Results: All patients were followed up at intervals of three weeks, three months, six months and then yearly (cases with minimum 3 follow ups were included in this study). According to HHS our results are as : 40.3% -excellent; 21.0% -good; 29.0% -fair; 9.7% -poor. No significant side effects or complications were observed so far. Conclusion: Core decompression by laser osteoperforation has been proven so far to be an effective, safe and minimally invasive treatment modality for AVN of the femoral head.