Core decompression procedures have been used in osteonecrosis of the femoral head to attempt to delay the joint destruction
that may necessitate hip arthroplasty. The efficacy of core decompressions has been variable with many variations of technique
described. To determine whether the efficacy of this procedure has improved during the last 15 years using modern techniques,
we compared recently reported radiographic and clinical success rates to results of surgeries performed before 1992. Additionally,
we evaluated the outcomes of our cohort of 52 patients (79 hips) who were treated with multiple small-diameter drillings.
There was a decrease in the proportion of patients undergoing additional surgeries and an increase in radiographic success
when comparing pre-1992 results to patients treated in the last 15 years. However, there were fewer Stage III hips in the
more recent reports, suggesting that patient selection was an important reason for this improvement. The results of the small-diameter
drilling cohort were similar to other recent reports. Patients who had small lesions and were Ficat Stage I had the best results
with 79% showing no radiographic progression. Our study confirms core decompression is a safe and effective procedure for
treating early stage femoral head osteonecrosis.
Level of Evidence: Level IV, therapeutic study (see the Guidelines for Authors for a complete description of levels of evidence).
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations
were conducted in conformity with ethical principles of research.