Minimally invasive core decompression with/without valgus intertrochanteric osteotomy for early-to-early-collapse avascular necrosis of the femoral head: A prospective case series.

introductionAvascular necrosis (AVN) of the femoral head is a progressive condition caused by disrupted blood supply, potentially leading to joint collapse. Common causes include trauma, corticosteroid use, alcohol abuse, and systemic conditions like systemic lupus erythematosus (SLE). Early intervention aims to preserve the joint and delay the need for total hip arthroplasty. This study evaluates the effectiveness of rotational osteotomy and core decompression in managing early-stage AVN. PRESENTATION OF CASE: Five patients with early-stage AVN underwent either rotational osteotomy or core decompression. Outcomes were assessed based on pain relief and joint function over 28 to 43 months of follow-up. All patients experienced significant improvement, with Harris Hip Scores (HHS) ranging from 83 to 88. DISCUSSION: Both procedures were effective in relieving pain and improving hip function. Core decompression likely achieved results through intraosseous pressure reduction and neovascularization, while rotational osteotomy offloaded the necrotic area. These joint-preserving techniques appear to offer durable benefits in young, active individuals, potentially delaying more invasive interventions.

conclusionRotational osteotomy and core decompression are viable surgical options for early-stage AVN of the femoral head. Both demonstrated favorable long-term outcomes in pain reduction and functional improvement. Larger studies are needed to confirm these findings and refine treatment guidelines.