title: MRI Evaluation of Post Core Decompression Changes in Avascular Necrosis of Hip.
abstract: BACKGROUND
  Avascular necrosis of hip typically presents in young patients. Core decompression in precollapse stage provides pain relief and preservation of femoral head. The results of core decompression vary considerably despite early diagnosis. The role of MRI in monitoring patients post surgically has not been clearly defined.
  
  
  OBJECTIVE
  To study pre and post core decompression MRI changes in avascular necrosis of hip.
  
  
  METHODS
  This is a contiguous observational cohort of 40 hips treated by core decompression for precollapse avascular necrosis of femoral head, who had a baseline MRI performed before surgery. Core decompression of the femoral head was performed within 4 weeks. Follow up radiograph and MRI scans were done at six months. Harris hip score preoperatively, 1 month and 6 months after the surgery was noted. Success in this study was defined as postoperative increase in Harris hip score (HHS) by 20 points and no additional femoral collapse. End point of clinical adverse outcome as defined by fall in Harris hip score was conversion or intention to convert to total hip replacement (THR). MRI parameters in the follow up scan were compared to the preoperative MRI. Effect of core decompression on bone marrow oedema and femoral head collapse was noted. Results were analysed using SPSS software version.
  
  
  RESULTS
  Harris hip score improved from 57 to 80 in all patients initially. Six hips had a fall in Harris hip score to mean value of 34.1 during follow up (9 to 12 months) and underwent total hip replacement. MRI predictors of positive outcome are lesions with grade A extent, Grade A & B location. Bone marrow oedema with lesions less than 50% involvement, medial and central location.
  
  
  CONCLUSIONS
  Careful selection of patients by MR criteria for core decompression provides satisfactory outcome in precollapse stage of avascular necrosis of hip.
authors.affiliation: Associate Professor, Department of Radiology, Deccan College of Medical Sciences , Hyderabad, India .
authors.forename: Madhavi
authors.initials: M
authors.lastname: Nori
authors.affiliation: Assistant Professor, Department of Radiology, Deccan College of Medical Sciences , Hyderabad, India .
authors.forename: Sravan Kumar
authors.initials: SK
authors.lastname: Marupaka
authors.affiliation: Junior Resident, Department of Radiology, Deccan College of Medical Sciences , Hyderabad, India .
authors.forename: Swathi
authors.initials: S
authors.lastname: Alluri
authors.affiliation: Senior Resident, Department of Radiology, Deccan College of Medical Sciences , Hyderabad, India .
authors.forename: Naseeruddin
authors.initials: N
authors.lastname: Md
authors.affiliation: Assistant Professor, Department of Radiology, Deccan College of Medical Sciences , Hyderabad, India .
authors.forename: Kazi Amir
authors.initials: KA
authors.lastname: Irfan
authors.affiliation: Professor, Department of Radiology, Princess Esra Hospital, Deccan College of Medical Sciences , Telangana, India .
authors.forename: Venkateshwarlu
authors.initials: V
authors.lastname: Jampala
authors.affiliation: Co-Director, Chief of Sports Medicine, Sunshine Hospitals Madhapur , Telangana, India .
authors.forename: Sunil
authors.initials: S
authors.lastname: Apsingi
authors.affiliation: Director, Orthopaedics & Chief Primary and Revision Hip and Knee Replacement, Sunshine Hospitals Madhapur , Telangana, India .
authors.forename: Krishna Kiran
authors.initials: KK
authors.lastname: Eachempati
keywords: AVN; Clinical outcome; Core decompression; Harris hipscore; MRI; Total hip arthroplasty
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