Outcomes of Hip Decompression With Segmental Elevation of Necrosis in Advanced Osteonecrosis of the Femoral Head.

Abstract

Hip decompression (HD) has shown promising outcomes for osteonecrosis of the femoral head (ONFH), particularly in early stages. Prompt intervention may delay progression to total hip arthroplasty (THA). This study evaluated outcomes of HD with elevation of the collapsed segment in patients who had advanced stages of ONFH, specifically those who had segmental collapse of the femoral head. We included 11 patients (12 hips) who underwent HD with elevation of a collapsed femoral head segment between 2007 and 2020. There were five hips classified as Association Research Circulation Osseous IIIA and seven IIIB. According to the Japanese Investigation Committee classification, six hips were type C1 and six were type C2. There were four patients who underwent HD via surgical hip dislocation to confirm segmental elevation, while the remaining patients underwent percutaneous decompression, where necrotic segment elevation was achieved under pressure with delivery of bone marrow concentrate and demineralized bone matrix. Demographics, risk factors, imaging, operative details, pain scales, and activity-level assessments were collected and analyzed. Of the 12 hips (58.3%), seven remained free from THA or reoperation at an average follow-up of 7.6 years (range, 4.1 to 10.9). Pain at the latest follow-up decreased to a mean of 4 of 10 (range, 1 to 5), compared with preoperative values of 7.8 of 10 (range, 6 to 9). Among these hips, patients maintained high functional activity, with scores of 7 or above in the University of California Los Angeles Activity Scale. There were five hips (41.7%) converted to THA at an average of 3.8 years (range, 11 months to 9.5 years), four of which were in type C2 hips. HD with segmental elevation, particularly in C1 hips, may delay THA and improve function in cases that might otherwise require it. This procedure offers a less invasive hip preservation option for later-stage ONFH without affecting future THA.