Treatment of Femoral Head Osteonecrosis (Stages 2B, 3 Ficat) Through Open Direct Core Decompression by Allograft Impaction and Light Bulb Technique

Femoral head avascular necrosis is the cause of paralyzing status of youth population. Initial diagnosisis the main element in treating the disease. Bone grafting and core decompression are the approved cures at the earlysteps of the disease. Hip replacement in a total manner is the common cure in the final stages. The optimal treatment inthe intermediate stages is partially disputable. We investigated several patients with femoral head osteonecrosis curedwith impacted cancellous allograft and open core decompression using the lightbulb technique.

A total of 46 patients (58 hips) suffering from femoral head osteonecrosis were evaluated in this crosssectionalstudy. Patients were classified into two groups: A (stage 2B Ficat) and B (stage 3 Ficat) to be treated with theimpaction of cancellous allograft and by open core decompression. Radiographic results, demographic data, and rangeof hip joint motions were recorded. The patients were assessed through employing the Harris hip score (HHS) andvisual analogue scale (VAS) index prior to operation and over five years following surgery. We also studied radiographicalterations of femoral head.

The means of HHS and VAS were developed following the operation. Radiographic outcomes promoted inboth groups, however, it was better in group A. 12 (40%) and six (22%) hips (40%) in groups A and B, respectivelydisplayed developed stages following the operation. The hip ROM was enhanced with the mean of 15-20 degrees(p <0.005).

Open core decompression combined with allograft impaction sounds to be influential in the developingsteps of femoral head necrosis and leads to joint discomfort and diminished pain improving ROM of the hip joint andmeanwhile procrastinating the worsening of the disease.Level of evidence: IV