Skip to main content
SpringerLink
Log in

A current review of core decompression in the treatment of osteonecrosis of the femoral head

  • Modern Surgical Treatment of Hip Avascular Necrosis (MA Mont, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

The review describes the following: (1) how traditional core decompression is performed, (2) adjunctive treatments, (3) multiple percutaneous drilling technique, and (4) the overall outcomes of these procedures. Core decompression has optimal outcomes when used in the earliest, precollapse disease stages. More recent studies have reported excellent outcomes with percutaneous drilling. Furthermore, adjunct treatment methods combining core decompression with growth factors, bone morphogenic proteins, stem cells, and bone grafting have demonstrated positive results; however, larger randomized trial is needed to evaluate their overall efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yoon TR, Song EK, Rowe SM, Park CH. Failure after core decompression in osteonecrosis of the femoral head. Int Orthop. 2001;24(6):316.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Iorio R, Healy WL, Abramowitz AJ, Pfeifer BA. Clinical outcome and survivorship analysis of core decompression for early osteonecrosis of the femoral head. J Arthroplasty. 1998;13(1):34.

    Article  CAS  PubMed  Google Scholar 

  3. Mazieres B, Marin F, Chiron P, Moulinier L, Amigues JM, Laroche M, et al. Influence of the volume of osteonecrosis on the outcome of core decompression of the femoral head. Ann Rheum Dis. 1997;56(12):747.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Mont MA, Jones LC, Pacheco I, Hungerford DS. Radiographic predictors of outcome of core decompression for hips with osteonecrosis stage III. Clin Orthop Relat Res. 1998;(354):159.

  5. Koo KHMM, Jones LC. Osteonecrosis. New York: Springer; 2014.

    Book  Google Scholar 

  6. Ficat PAJ. Functional investigation of bone under normal conditions. In: Ficat PAJ, Hungerford DS, editors. Ischemia and necroses of bone, vol. 29. Baltimore: Williams & Wilkins; 1961.

    Google Scholar 

  7. Zhang Y, Li L, Shi ZJ, Wang J, Li ZH. Porous tantalum rod implant is an effective and safe choice for early-stage femoral head necrosis: a meta-analysis of clinical trials. Eur J Orthop Surg Traumatol Ortho Traumatol. 2013;23(2):211.

    Article  Google Scholar 

  8. Li X, Xu X, Wu W. Comparison of bone marrow mesenchymal stem cells and core decompression in treatment of osteonecrosis of the femoral head: a meta-analysis. Int J Clin Exp Pathol. 2014;7(8):5024.

    PubMed Central  PubMed  Google Scholar 

  9. Nadeau M, Seguin C, Theodoropoulos JS, Harvey EJ. Short term clinical outcome of a porous tantalum implant for the treatment of advanced osteonecrosis of the femoral head. McGill J Med MJM Int Forum Adv Med Sci Stud. 2007;10(1):4.

    Google Scholar 

  10. Gangji V, Hauzeur JP, Matos C, De Maertelaer V, Toungouz M, Lambermont M. Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. A pilot study. J Bone Joint Surg Am. 2004;86-A(6):1153.

    PubMed  Google Scholar 

  11. Liu ZH, Guo WS, Li ZR, Cheng LM, Zhang QD, Yue DB, et al. Porous tantalum rods for treating osteonecrosis of the femoral head. Genet Mol Res. 2014;13(4):8342.

    Article  CAS  PubMed  Google Scholar 

  12. Marker DR, Seyler TM, Ulrich SD, Srivastava S, Mont MA. Do modern techniques improve core decompression outcomes for hip osteonecrosis? Clin Orthop Relat Res. 2008;466(5):1093.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Saito S, Ohzono K, Ono K. Joint-preserving operations for idiopathic avascular necrosis of the femoral head. Results of core decompression, grafting and osteotomy. J Bone Joint Surg. 1988;70(1):78.

    CAS  Google Scholar 

  14. Hopson CN, Siverhus SW. Ischemic necrosis of the femoral head. Treatment by core decompression. J Bone Joint Surg Am. 1988;70(7):1048.

    CAS  PubMed  Google Scholar 

  15. Bozic KJ, Zurakowski D, Thornhill TS. Survivorship analysis of hips treated with core decompression for nontraumatic osteonecrosis of the femoral head. J Bone Joint Surg Am. 1999;81(2):200.

    CAS  PubMed  Google Scholar 

  16. Koo KH, Kim R, Ko GH, Song HR, Jeong ST, Cho SH. Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression. J Bone Joint Surg. 1995;77(6):870.

    CAS  Google Scholar 

  17. Simank HG, Brocai DR, Strauch K, Lukoschek M. Core decompression in osteonecrosis of the femoral head: risk-factor-dependent outcome evaluation using survivorship analysis. Int Orthop. 1999;23(3):154.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Solomon L. Idiopathic necrosis of the femoral head: pathogenesis and treatment. Can J Surg J Can Chir. 1981;24(6):573.

    CAS  Google Scholar 

  19. Ficat RP. Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment. J Bone Joint Surg. 1985;67(1):3.

    CAS  Google Scholar 

  20. Lafforgue P, Dahan E, Chagnaud C, Schiano A, Kasbarian M, Acquaviva PC. Early-stage avascular necrosis of the femoral head: MR imaging for prognosis in 31 cases with at least 2 years of follow-up. Radiology. 1993;187(1):199.

    Article  CAS  PubMed  Google Scholar 

  21. Stulberg BN, Bauer TW, Belhobek GH. Making core decompression work. Clin Orthop Relat Res. 1990;(261):186.

  22. Aaron RK, Lennox D, Bunce GE, Ebert T. The conservative treatment of osteonecrosis of the femoral head. A comparison of core decompression and pulsing electromagnetic fields. Clin Orthop Relat Res. 1989;(249):209.

  23. Kane SM, Ward WA, Jordan LC, Guilford WB, Hanley Jr EN. Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis. Orthopedics. 1996;19(10):869.

    CAS  PubMed  Google Scholar 

  24. Markel DC, Miskovsky C, Sculco TP, Pellicci PM, Salvati EA. Core decompression for osteonecrosis of the femoral head. Clin Orthop Relat Res. 1996;(323):226.

  25. Chang MC, Chen TH, Lo WH. Core decompression in treating ischemic necrosis of the femoral head. Zhonghua Yi Xue Za Zhi Chin Med J. 1997;60(3):130. Free China ed.

    CAS  Google Scholar 

  26. Scully SP, Aaron RK, Urbaniak JR. Survival analysis of hips treated with core decompression or vascularized fibular grafting because of avascular necrosis. J Bone Joint Surg Am. 1998;80(9):1270.

    CAS  PubMed  Google Scholar 

  27. Powell ET, Lanzer WL, Mankey MG. Core decompression for early osteonecrosis of the hip in high risk patients. Clin Orthop Relat Res. 1997;(335):181.

  28. Ha YC, Jung WH, Kim JR, Seong NH, Kim SY, Koo KH. Prediction of collapse in femoral head osteonecrosis: a modified Kerboul method with use of magnetic resonance images. J Bone Joint Surg Am. 2006;88 Suppl 3:35.

    Article  PubMed  Google Scholar 

  29. Aigner N, Schneider W, Eberl V, Knahr K. Core decompression in early stages of femoral head osteonecrosis—an MRI-controlled study. Int Orthop. 2002;26(1):31.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Bellot F, Havet E, Gabrion A, Meunier W, Mertl P, de Lestang M. Core decompression of the femoral head for avascular necrosis. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(2):114.

    Article  CAS  PubMed  Google Scholar 

  31. Chen CH, Chang JK, Huang KY, Hung SH, Lin GT, Lin SY. Core decompression for osteonecrosis of the femoral head at pre-collapse stage. Kaohsiung J Med Sci. 2000;16(2):76.

    CAS  PubMed  Google Scholar 

  32. Rajagopal M, Balch Samora J, Ellis TJ. Efficacy of core decompression as treatment for osteonecrosis of the hip: a systematic review. Hip Int J Clin Exp Res Hip pathol Ther. 2012;22(5):489. This is a small systematic review displaying satisfactory efficacy of traditional core decompression.

    Google Scholar 

  33. Maniwa S, Nishikori T, Furukawa S, Kajitani K, Iwata A, Nishikawa U, et al. Evaluation of core decompression for early osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2000;120(5–6):241.

    Article  CAS  PubMed  Google Scholar 

  34. Lavernia CJ, Sierra RJ. Core decompression in atraumatic osteonecrosis of the hip. J Arthroplasty. 2000;15(2):171.

    Article  CAS  PubMed  Google Scholar 

  35. Fairbank AC, Bhatia D, Jinnah RH, Hungerford DS. Long-term results of core decompression for ischaemic necrosis of the femoral head. J Bone Joint Surg. 1995;77(1):42.

    CAS  Google Scholar 

  36. Amanatullah DF, Farac R, McDonald TJ, Moehring HD, Di Cesare PE. Subtrochanteric fracture following removal of a porous tantalum implant. Case Rep Orthop. 2013;2013:946745.

    PubMed Central  PubMed  Google Scholar 

  37. Liu G, Wang J, Yang S, Xu W, Ye S, Xia T. Effect of a porous tantalum rod on early and intermediate stages of necrosis of the femoral head. Biomed Mater. 2010;5(6):065003.

    Article  PubMed  Google Scholar 

  38. Yang SH, Fu DH, Yang C, Li J, Xu WH, Ye SN, et al. Clinical result of structural augmentation with cannulated bone screws for the treatment of osteonecrosis of the femoral head. Orthop Surg. 2009;1(1):42.

    Article  PubMed  Google Scholar 

  39. Floerkemeier T, Thorey F, Daentzer D, Lerch M, Klages P, Windhagen H, et al. Clinical and radiological outcome of the treatment of osteonecrosis of the femoral head using the osteonecrosis intervention implant. Int Orthop. 2011;35(4):489.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Veillette CJ, Mehdian H, Schemitsch EH, McKee MD. Survivorship analysis and radiographic outcome following tantalum rod insertion for osteonecrosis of the femoral head. J Bone Joint Surg Am. 2006;88 Suppl 3:48.

    Article  PubMed  Google Scholar 

  41. Yang P, Bian C, Huang X, Shi A, Wang C, Wang K. Core decompression in combination with nano-hydroxyapatite/polyamide 66 rod for the treatment of osteonecrosis of the femoral head. Arch Orthop Trauma Surg. 2014;134(1):103.

    Article  PubMed  Google Scholar 

  42. Wei BF, Ge XH. Treatment of osteonecrosis of the femoral head with core decompression and bone grafting. Hip Int J Clin Exp Res Hip Pathol Ther. 2011;21(2):206.

    Google Scholar 

  43. Hsu JE, Wihbey T, Shah RP, Garino JP, Lee GC. Prophylactic decompression and bone grafting for small asymptomatic osteonecrotic lesions of the femoral head. Hip Int J Clin Exp Res Hip Pathol Ther. 2011;21(6):672.

    Google Scholar 

  44. Keizer SB, Kock NB, Dijkstra PD, Taminiau AH, Nelissen RG. Treatment of avascular necrosis of the hip by a non-vascularised cortical graft. J Bone Joint Surg. 2006;88(4):460.

    Article  CAS  Google Scholar 

  45. Steinberg ME, Larcom PG, Strafford B, Hosick WB, Corces A, Bands RE, Hartman KE. Core decompression with bone grafting for osteonecrosis of the femoral head. Clin Orthop Relat Res. 2001;(386):71.

  46. Rijnen WH, Gardeniers JW, Buma P, Yamano K, Slooff TJ, Schreurs BW. Treatment of femoral head osteonecrosis using bone impaction grafting. Clin Orthop Relat Res. 2003;(417):74.

  47. Liu D, Chen Q, Chen Y, Liu Y. [Long-term follow-up of early-middle stage avascular necrosis of femoral head with core decompression and bone grafting]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Zhongguo Xiufu Chongjian Waike Za Zhi Chin J Reparative Reconstr Surg. 2012;26(10):1165.

    Google Scholar 

  48. Gangji V, Hauzeur JP. Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. Surgical technique. J Bone Joint Surg Am. 2005;87(Suppl 1(Pt 1)):106.

    PubMed  Google Scholar 

  49. Zhao D, Cui D, Wang B, Tian F, Guo L, Yang L, et al. Treatment of early stage osteonecrosis of the femoral head with autologous implantation of bone marrow-derived and cultured mesenchymal stem cells. Bone. 2012;50(1):325.

    Article  PubMed  Google Scholar 

  50. Sen RK, Tripathy SK, Aggarwal S, Marwaha N, Sharma RR, Khandelwal N. Early results of core decompression and autologous bone marrow mononuclear cells instillation in femoral head osteonecrosis: a randomized control study. J Arthroplasty. 2012;27(5):679. This study displays shows using bone marrow cells as an adjunctive therapy to core decompression may further improve outcomes.

    Article  PubMed  Google Scholar 

  51. Shuler MS, Rooks MD, Roberson JR. Porous tantalum implant in early osteonecrosis of the hip: preliminary report on operative, survival, and outcomes results. J Arthroplasty. 2007;22(1):26.

    Article  PubMed  Google Scholar 

  52. Jiang LXL, Tong P. The clinical study of optimization scheme for the steroid-induced necorsis of femoral head ficat II stage. J Tradit Clin Orthop Traumatol. 2011;22(8):565.

    Google Scholar 

  53. Zhang JYS, Xu W, et al. Comparison of clinical results for two different methods for treatment of early osteonecrosis of the femoral head. J Pract Orthop. 2010;16(5):333.

    Google Scholar 

  54. Zhang YLY, Wei Q. Comparision of avascular necrosis porous tantulum implant and transplant of ilium bone flap with deep iliac circumflex vessels pedicle for the treatment of early-stage femoral head necrosis. Orthop J China. 2011;149(15):1311.

    Google Scholar 

  55. Chen JBS, Liu Z, et al. A comparative study for the treatment of necrosis of the femoral head of core decompress with bone graft or tantalum screw. J Pract Orthop. 2011;17(4):325.

    Google Scholar 

  56. Song WS, Yoo JJ, Kim YM, Kim HJ. Results of multiple drilling compared with those of conventional methods of core decompression. Clin Orthop Relat Res. 2007;454:139.

    Article  PubMed  Google Scholar 

  57. Mont MA, Ragland PS, Etienne G. Core decompression of the femoral head for osteonecrosis using percutaneous multiple small-diameter drilling. Clin Orthop Relat Res. 2004;(429):131

  58. Lee MS, Hsieh PH, Chang YH, Chan YS, Agrawal S, Ueng SW. Elevated intraosseous pressure in the intertrochanteric region is associated with poorer results in osteonecrosis of the femoral head treated by multiple drilling. J Bone Joint Surg. 2008;90(7):852.

    Article  CAS  Google Scholar 

  59. Al Omran A. Multiple drilling compared with standard core decompression for avascular necrosis of the femoral head in sickle cell disease patients. Arch Orthop Trauma Surg. 2013;133(5):609. This recent study demonstrates positive outcomes using the mutliple percutaneous drilling technique to decompression osteonecrotic lesions.

    Article  PubMed  Google Scholar 

Download references

Compliance with ethics guidelines

Conflict of interest

Todd P. Pierce, Julio J. Jauregui, and Randa K. Elmallah declare that they have no conflict of interest.

Carlos J. Lavernia reports personal fees from Stryker, personal fees from Wright Medical Technology, Inc., grants and personal fees from MAKO Surgical, personal fees from Johnson and Johnson, personal fees from Symmetry Medical, personal fees from Zimmer, outside the submitted work. He is also a board member of the American Association of Hip and Knee Surgeons, the Florida Orthopaedic Society, and the Journal of Arthroplasty.

Michael A. Mont has received grants and personal fees from Stryker, Wright Medical Technology, Inc., DJ Orthopaedics, Joint Active Systems, Sage Products, Inc., and TissueGene. Dr. Mont has also received personal fees from Janssen, Medical Compression Systems, Medtronic, and grants from the National Institutes of Health (NIAMS and NICHD). Dr. Mont also serves on the editorial/governing board of the American Journal of Orthopedics, Journal of Arthroplasty, Journal of Bone and Joint Surgery (American), Journal of Knee Surgery, Orthopedics, and Surgical Techniques International and is also a board member/committee appointment for the AAOS Society.

James Nace reports receiving consultancy fees from InforMD and grants from Stryker.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    Todd P. Pierce, Julio J. Jauregui, Randa K. Elmallah, Michael A. Mont & James Nace

  2. The Center for Advanced Orthopedics at Larkin, South Miami, USA

    Carlos J. Lavernia

Authors
  1. Todd P. Pierce
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julio J. Jauregui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Randa K. Elmallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlos J. Lavernia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael A. Mont
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James Nace
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James Nace.

Additional information

This article is part of the Topical Collection on Modern Surgical Treatment of Hip Avascular Necrosis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pierce, T.P., Jauregui, J.J., Elmallah, R.K. et al. A current review of core decompression in the treatment of osteonecrosis of the femoral head. Curr Rev Musculoskelet Med 8, 228–232 (2015). https://doi.org/10.1007/s12178-015-9280-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-015-9280-0

Keywords

Search

Navigation