Core decompression is a minimally invasive operation for early-stage avascular necrosis (AVN) of the femoral head. It involves drilling into the femoral head to reduce pressure, improve blood flow, and delay or prevent the need for hip replacement.
Under X-ray guidance, a drill or trocar is passed through the outer thigh into the femoral head, creating one or more channels. This releases the elevated pressure within the bone and allows new blood vessels to grow. Bone graft, bone marrow aspirate, or synthetic bone substitutes may be packed into the channels. The procedure takes 30-60 minutes.
Core decompression is most effective for early-stage AVN (before the femoral head has collapsed). Once collapse occurs, hip replacement is usually more appropriate.
Weight-bearing restriction, bisphosphonate medication, and observation. However, untreated AVN usually progresses to femoral head collapse.
MRI to stage the AVN. Blood tests to investigate underlying causes. Day-case or overnight procedure.
For early-stage disease, core decompression can delay or prevent femoral head collapse in approximately 60-70% of patients at five years. It is a joint-preserving procedure that may defer or avoid hip replacement.
Discomfort in the lateral thigh at the drill site for several weeks.
Crutches needed for six weeks to protect the femoral head.
Rare fracture through the drill hole. Risk is minimised by using smaller diameter channels.
AVN may progress despite treatment, eventually requiring hip replacement.
Very rare.
Bleeding at the drill site.
General or spinal anaesthesia.
Non-weight-bearing or partial weight-bearing for six weeks. Physiotherapy for hip range of motion. MRI follow-up to monitor disease progression. Return to full activities at three months.
MRI at three months and six months to monitor AVN progression. Regular long-term follow-up.
AVN occurs when blood supply to the femoral head is disrupted. Common causes include corticosteroid use, alcohol excess, sickle cell disease, hip fracture, and sometimes no identifiable cause (idiopathic).
Possibly. Core decompression works best in early disease and may delay but not always prevent the need for replacement. If the femoral head collapses, hip replacement is usually recommended.