title: Operative technique and results of core decompression and filling with bone grafts in the treatment of osteonecrosis of femoral head.
abstract: BACKGROUND
  The aim of this paper is to present the operative technique and results of core decompression and clearing of a necrotic zone in the femoral head followed by filling the defect with impacted autologous or synthetic bone grafts. This procedure allows for mechanical prevention of further collapse of the femoral head and loss of its spherical shape. It also creates conditions for the incorporation of the biological graft or synthetic bone.
  
  
  METHODS
  A series of 63 patients (72 hips) were treated for aseptic osteonecrosis of the femoral head between 1996 and 2009. This group comprised 42 men and 21 women aged 19 to 60 years (average age: 35 years). Radiographic staging of necrosis was based on the ARCO (Association Research Circulation Osseous) classification. All patients were treated with core decompression followed by filling the bone defect with autologous or synthetic (Wright ProDense) bone grafts.
  
  
  RESULTS
  Average follow-up was 5 years (from 1 to 12 years). After one year of follow-up, pain relief with preservation of a spherical femoral head was obtained in 45 hips (63%). Sixteen hips (22%) had significant limitation of the range of motion that, however, did not exceed preoperative values, with no significant pain during walking, and loss of the spherical shape of the femoral head on radiographs.
  
  
  CONCLUSIONS
  Filling the defect with morsellized or synthetic bone grafts followed by graft impaction creates mechanical and biological conditions for graft incorporation. Where collapse has not occurred during the first six post-operative months, a good and lasting result can be expected.
authors.affiliation: Trauma and Orthopaedic Department, Cardinal Stefan Wyszyński Regional Specialised Hospital, Lublin, Poland. urazowo_ortopedyczny@szpital.lublin.pl
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bednarek
authors.forename: Andrzej
authors.initials: A
authors.lastname: Atras
authors.forename: Jacek
authors.initials: J
authors.lastname: Gągała
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Kozak
mesh_terms: D000328:Adult; D016025:Bone Transplantation; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005271:Femur Head Necrosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome