Overview of core decompression
Core decompression is a surgical procedure that involves surgical drilling into the area of dead bone near the joint. This reduces pressure, allows for increased blood flow, and slows or stops bone and/or joint destruction. Core decompression is commonly performed to treat osteonecrosis.
Indications of core decompression
Decompression of the nucleus is indicated in the early stages of avascular necrosis when the surface of the head is still smooth and round. It is doing to prevent total hip replacement surgery, which is indicated for plain cases of avascular necrosis and involves the replacement of the hip joint with an artificial device or prosthesis.
Core decompression is complete under spinal or general anaesthesia. The patient is placed on his back in a supine position. Live X-ray images or fluoroscopy are used to guide your surgeon during the procedure.
A small incision is completed in the hip and a guidewire is approved from the incision through the neck of the femoral bone to the necrotic area on the femoral head. Then a hole is drilled along the wire. The necrotic bone is then removed. This immediately reduces the pressure and creates space for the new blood vessels to grow and nourish the existing bone.
The cavity that remains in the bone is sometimes filled with a bone graft taken from another part of the body or from a cadaver. Sometimes synthetic bone graft material is used. Then the incision is closed with stitches. An additional variation of the same surgery involves drilling very small diameter holes from a single point. The surgical wound in this case is very small and may require only one suture.
The benefits of core decompression include the following:
- Prevents complications of femoral head collapse.
- Preserves the femur bone.
- It delays the need for a total hip replacement where the diseased head of the femur is replaced with an artificial prosthesis.
Risks and complications
As with all surgeries, central decompression can be associated with certain complications such as:
- Fracture along the central line
- Femoral head perforations
- Deep venous thrombosis
What happens as a result of the decompression of the core?
To relieve the pressure that causes pain, your surgeon will drill a small hole in the diseased bone, using fluoroscopy to locate the exact area of the disease. By drilling a hole and creating space, the new fabric can fill in the hole. This allows blood vessels to regenerate and blood flow more easily to the area. The surgeon may also use bone grafts from other bones in your body, implanting the bone in the pierced area to stimulate bone growth.
In many cases, this procedure provides pain relief that can be immediate and even long-term. In other cases, however, it is simply a way to relieve pain and postpone the need for a total hip replacement (arthroplasty).
Diagnosis of osteonecrosis
Doctors have special expertise in diagnosing osteonecrosis, which can be difficult to diagnose because it closely resembles other conditions. Stanford offers advanced MRI imaging techniques that improve the accuracy of diagnoses.
Being diagnosed in the early stages of the condition can increase your chances of success with treatment and save more of your joint and bone tissue. In addition to a complete medical history and physical examination, diagnostic procedures for osteonecrosis include:
- CT scan
- Bone scan