Core Decompression for Avascular Necrosis of the Hip
The hip joint is a ball-and-socket joint, where the head of the thighbone (femur) articulates with the cavity (acetabulum) of the pelvic bone.
Sickle cell disease, a group of disorders that affect the haemoglobin or oxygen-carrying component of blood, causes avascular necrosis or the death of the bone tissue in the hip due to lack of blood supply.
Avascular necrosis commonly affects the head of the femur. Necrosis leads to tiny cracks on the bone, which finally causes the head of the femur to collapse. The condition causes pain due to increased pressure in the blood vessels of the bone marrow at the region of the necrosis.
Early stages of avascular necrosis can be treated by core decompression surgery, which reduces pressure, promotes blood flow and encourages the healing of the bone.
Indications
Core decompression is indicated in the early stages of avascular necrosis, when the surface of the head is still smooth and round. It is done to prevent total hip replacement surgery, which is indicated for severe cases of avascular necrosis, and involves the replacement of the hip joint with an artificial device or prosthesis.
Surgical procedure
Core decompression is performed under spinal or general anaesthesia. You will be placed on your back in a supine position. Live X-ray imaging or fluoroscopy is used to guide your surgeon during the procedure.
A small incision is made on your hip and a guide wire is passed from the incision through the neck of the femoral bone to the necrotic area in the femoral head. A hole is then drilled along the wire and the necrotic bone is removed. This reduces the pressure immediately and creates space for the new blood vessels to grow and nourish the existing bone.
The cavity that is left behind in the bone is sometimes filled with bone graft taken either from another part of your body or a cadaver. Sometimes, synthetic bone graft material is used. The incision is then closed with sutures. Another variation of the same surgery involves drilling very small diameter holes from a single point. The surgical wound in this case is very small and may require only a single suture.
Postoperative care
After the operation, crutches are to be used for 6 to 12 weeks to prevent weightbearing at the hip joint until the femur bone heals completely. You will be able to resume your regular activities 3 months after the surgery.
Advantages
The advantages of core decompression include the following:
- Prevents complications of the collapse of the femoral head
- Preserves bone of the femur
- Delays the need for total hip replacement where the diseased femur head is replaced with an artificial prosthesis
Risks and complications
As with all surgeries, core decompression may be associated with certain complications such as:
- Fracture along the core track
- Perforations in the femoral head
- Deep vein thrombosis
