Core decompression

Core decompression

ICD-10	0S5
ICD-9	80.09
MeSH	D019637
OPS-301	5-820

Core decompression is a surgical procedure used to treat avascular necrosis (AVN) of the bone, particularly in the hip joint. This procedure aims to relieve pain and halt the progression of bone and joint destruction by reducing the pressure within the bone and improving blood flow.

Indications

Core decompression is primarily indicated for patients with early-stage avascular necrosis, particularly in the femoral head. It is most effective when performed before the collapse of the bone structure. The procedure is considered when conservative treatments, such as medication and physical therapy, have failed to alleviate symptoms.

Pathophysiology

Avascular necrosis occurs when there is a loss of blood supply to the bone, leading to the death of bone tissue. This can result from trauma, long-term use of high-dose corticosteroids, excessive alcohol consumption, or certain medical conditions like sickle cell disease. The lack of blood flow causes the bone to weaken and collapse, leading to arthritis and joint dysfunction.

Procedure

Core decompression involves drilling one or more holes into the affected bone to reduce pressure, create channels for new blood vessels, and stimulate healing. The procedure can be performed using various techniques, including:

Traditional Core Decompression

In this method, a large-diameter drill is used to create a single channel into the necrotic area of the bone. This channel reduces intraosseous pressure and allows for revascularization.

Multiple Small Drill Holes

This technique involves creating several small drill holes in the affected area. It is believed to provide better decompression and stimulate more extensive revascularization compared to a single large channel.

Advanced Techniques

Advanced techniques may involve the use of bone grafts or stem cell therapy to enhance the healing process. These methods aim to provide structural support and promote the regeneration of healthy bone tissue.

Postoperative Care

After core decompression, patients typically undergo a period of limited weight-bearing on the affected limb to allow for healing. Physical therapy is often recommended to restore joint function and strength. The success of the procedure depends on the stage of avascular necrosis and the patient's adherence to postoperative care instructions.

Outcomes

The success rate of core decompression varies, with better outcomes generally observed in patients with early-stage avascular necrosis. The procedure can delay or prevent the need for more invasive surgeries, such as total hip arthroplasty. However, in advanced cases where the bone has already collapsed, core decompression may be less effective.

Complications

Potential complications of core decompression include infection, fracture of the bone, and incomplete pain relief. In some cases, the procedure may not prevent the progression of avascular necrosis, necessitating further surgical intervention.

Alternatives

Alternative treatments for avascular necrosis include non-surgical options like medication and lifestyle modifications, as well as surgical options such as osteotomy, bone grafting, and joint replacement surgery.

See also

• Avascular necrosis
• Femoral head
• Bone grafting
• Stem cell therapy