ePoster #201 - ISHA Annual Scientific Meeting 2016

Core Decompression and Hip Arthroscopy is Only Useful in Osteonecrosis of the Femoral Head Ficat and Steinberg Stages I And II

Antonio Porthos Salas, MD, San Pedro, Garza Garcia MEXICO

Hip Arthroscopy MEXICO , Monterrey , Nuevo Leon , MEXICO

FDA Status Not Applicable

Summary: Core decompression and retrograde impacted allograft with Hip Arthroscopy is only useful in Osteonecrosis of the Femoral Head Ficat and Steinberg stages I and II.

Femoral head osteonecrosis (FHON) is a devastating disease that affects the young, the young adult and also very active population. Presenting with severe dysfunction, loss of mobility and decrease quality of life and sport related activities. ONFH is a pathology, which involves disruption of the circulation of the femoral head cancellous bone, resulting in subchondral sclerosis, subchondral caseous necrosis, bone infarction, weakness and collapse, leading to cartilage thinning, depression and breakage that results in hip osteoarthritis.
Various etiologies have been identified, as the causative agents of ONFH like: chronic use of cortisone, alcohol, coagulation discrasias, lipid disorders, hip fractures, hip dislocation, traumatic events, idiopathic and many more. Nowadays the main goals of treatment are preservative and joint salvage procedures. Treatments in HA and hip preservation surgery are focused to preserve as much as possible the hip joint cartilage.
Core decompression treatment aided with hip arthroscopy for ONFH remains controversial due to the actual results in the literature. The aid of arthroscopic vision during the decompression of the FH has the advantage to the traditional technique because of the direct observation of the femoral head cartilage, it visualize its conditions and the existence of cartilage breakage and collapse and also if the core decompression will be of a benefit to the patient. We believe that core decompression with hip arthroscopy for ONFH offers minimal and a less invasive surgical procedure and very reliable in staging and diagnosing the disease. Also we believe and encourage performing a single stage total hip replacement if needed and when the chondral lesions are irreparable. We strongly believe that core decompression and hip arthroscopy is only useful in ONFH stages Ficat/Steinberg I and II. We strongly recommend proceeding with another salvation or inclusively with a joint replacement procedure in Ficat/Steinberg III where you have a radiographic crescent sign and also an arthroscopic step off the femoral head cartilage. Our study demonstrates that core decompression with HA and retrograde allograft fill is an excellent choice for treatment in early-stages of ONFH.