title: Arthroscopic management and platelet-rich plasma therapy for avascular necrosis of the hip.
abstract: OBJECTIVE
  The purpose is to describe a noninvasive arthroscopic procedure as an alternative to open surgery for avascular necrosis of the hip.
  
  
  METHODS
  Patients with grade I or IIA avascular necrosis of the hip are treated by core decompression performed by drilling under fluoroscopic guidance. Liquid platelet-rich plasma (PRP) is delivered through a trocar, saturating the necrotic area. In more severe conditions, the necrotic bone is decompressed and debrided, through a cortical window at the head-neck junction. A composite graft made of autologous bone and PRP is delivered by impactation through the core decompression track. Fibrin membranes are applied to enhance healing of the head-neck window and arthroscopic portals. Platelet-rich plasma is infiltrated in the central compartment.
  
  
  RESULTS
  This arthroscopic approach aids in making diagnosis of the labrum and articular cartilage and permits intra-operative treatment decisions. Visual control permits the precise localization and treatment for the necrotic area allowing cartilage integrity to be preserved.
  
  
  CONCLUSIONS
  Arthroscopic management of avascular necrosis of the femoral head is viable and has significant advantages. Clinical studies should justify the theoretical additional benefits of this approach.
authors.affiliation: Unidad de Cirugía Artroscópica, UCA Mikel Sánchez, Clínica USP-La Esperanza, c/La Esperanza 3, 01002 Vitoria-Gasteiz, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Guadilla
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fiz
authors.forename: Isabel
authors.initials: I
authors.lastname: Andia
authors.forename: Mikel
authors.initials: M
authors.lastname: Sánchez
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D019299:Decompression, Surgical; D005271:Femur Head Necrosis / Q000175:diagnosis / Q000601:surgery*; D005337:Fibrin / Q000008:administration & dosage; D006801:Humans; D053657:Platelet-Rich Plasma
chemical_list: D005337:Fibrin