Evaluating Core Decompression with Fibular Bone Allograft in Osteonecrosis of the Femoral Head: A Systematic Review.

Abstract

Osteonecrosis of the femoral head (ONFH) is a debilitating condition often leading to total hip arthroplasty (THA). Core decompression with fibular bone allograft is a promising technique to delay THA, especially in younger patients. This study evaluates the effectiveness of core decompression with fibular bone allograft in preserving the femoral head in ONFH patients. A systematic literature review was conducted using PubMed and Scopus. From 662 articles, 5 studies were included, encompassing 311 patients (373 hips) with a mean age of 37.27 years and an average follow-up of 85.53 months. Outcomes analyzed included Harris hip scores, THA incidence, clinical and radiological success, and complications. Steroid use was the leading cause of ONFH in 50% of cases. Four studies reported significant improvements in Harris hip scores. THA incidence was 8.5 and 34.5% at 4 and 14 years of follow-up, respectively. Clinical success ranged from 38 to 88%, and radiological success from 31 to 70%. Complications were rare, occurring in 1.9% of cases (6 instances). Core decompression with fibular bone allograft is a low-cost, technically simple procedure that achieves high patient satisfaction, minimal complications, and favorable clinical outcomes. It is a viable option for preserving the femoral head and delaying THA in ONFH patients, particularly younger individuals.