Results of core decompression for femoral head osteonecrosis

The progression of femoral head osteonecrosis (FHON) culminates in destruction of the hip joint, a devastating consequence for young people who are predominantly affected. Core decompression, as a means of ameliorating the disease, was evaluated in 45 hips in 33 patients with nontraumatic FHON. The mean clinical and roentgenographic follow-up period was three years (range, 1-7 years). None of the ten Ficat Stage I hips progressed, 11 of 26 Stage II hips progressed, and five of nine Stage III hips progressed to coxarthrosis. In those hips in which there was an association with steroid therapy, there was 50% progression when steroids were continued, compared with 22% progression when steroids had been discontinued. Core decompression is prescribed for Ficat Stage I and II. Patients on continuous post-operative treatment with steroids for associated conditions should be advised of the high risk of progression.