title: Analysis of outcome of avascular necrosis of femoral head treated by core decompression and bone grafting.
abstract: BACKGROUND
  Femoral head is the most common bone affected by avascular necrosis. Core decompression procedure, when done in the initial stages, before collapse, may arrest or reverse the progress of avascular necrosis and thereby may preserve the normal femoral head. Hence, we have analysed the clinical, functional and radiological outcome of core decompression and bone grafting in patients with Osteonecrosis of the femoral head (ONFH) upto stage IIB (Ficat & Arlet).
  
  
  METHODS
  A study was undertaken at our institute from June 2010 to June 2013 wherein 20 patients (28 hips) of ONFH upto grade II B (Ficat & Arlet) were treated with core decompression and the outcomes were studied. Patients were subjected to core decompression of the affected hip. All the patients were operated in lateral position. In 26/28 hips, cancellous grafting was done after harvesting graft from the posterior iliac crest. In 2 patients cortical non-vascularised fibular graft was used.
  
  
  RESULTS
  Functional outcome was assessed by Harris hip score, wherein 19 hips (67.85%) had good or excellent outcome; 1 hip (3.57%) had fair out come. However, 8 hips (28.57%) showed poor result. For stage I, 12/13 hips (92.3%) improved, whereas for Stage IIA, 6/11 hips (54.54%) showed improvement and for stage IIB, only 2/4 hips (50%) showed improvement. Less than 25% of the hips required a replacement or salvage procedure. Strict non weight bearing was complied by 23 hips (82.14%), whereas 5 hips (17.85%) were not compliant. If we exclude non compliant patients, our success rate was 92.3% for grade I, 100% for grade IIA and 50% for grade IIB.
  
  
  CONCLUSIONS
  Core decompression and bone grafting provide satisfactory outcome when patients are carefully selected in early stages of the disease, before the stage of collapse.
authors.affiliation: Assistant Professor, Department of Orthopaedics, Smt. Bhikhiben Kanjibhai Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, Gujarat, India.
authors.forename: Smit N
authors.initials: SN
authors.lastname: Shah
authors.affiliation: Assistant Professor, Department of Orthopaedics, Smt. Bhikhiben Kanjibhai Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, Gujarat, India.
authors.forename: Chirag S
authors.initials: CS
authors.lastname: Kapoor
authors.affiliation: Assistant Professor, Department of Orthopaedics, Smt. Bhikhiben Kanjibhai Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, Gujarat, India.
authors.forename: Maulik R
authors.initials: MR
authors.lastname: Jhaveri
authors.affiliation: Assistant Professor, Department of Orthopaedics, Smt. Bhikhiben Kanjibhai Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, Gujarat, India.
authors.forename: Paresh P
authors.initials: PP
authors.lastname: Golwala
authors.affiliation: Assistant Professor, Department of Orthopaedics, Smt. Bhikhiben Kanjibhai Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, Gujarat, India.
authors.forename: Sagar
authors.initials: S
authors.lastname: Patel
keywords: Avascular necrosis; Bone grafting; Core decompression